Ventilator Associated Pneumonia due to Aeromonas hydrophila: A Rare Case Report
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Introduction Aeromonas hydrophila is an opportunistic pathogen that can cause various infections, including pneumonia, in immunocompromised individuals. This case report presents a rare occurrence of ventilator associated pneumonia (VAP) caused by Aeromonas hydrophila in an apparently non-immunocompromised patient. Case presentation The patient exhibited signs and symptoms of VAP and was successfully treated with intravenous Ciprofloxacin. The discussion highlights the characteristics of Aeromonas species, its virulence factors, risk factors for infection, and antibiotic profile. Conclusion It emphasizes the need for awareness and suspicion of Aeromonas as a potential cause of VAP in ICU settings, as well as the importance of early detection and appropriate treatment for improved outcomes.
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Thank you very much for submitting your revised manuscript to Access Microbiology and applying all the modifications suggested by the reviewers. The manuscript is now accepted for publication. Congratulations!
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Comments to Author
Description of the case - The case is described reasonably clearly, and the course of the disease process is clear to follow. The abstract and case description show that the patient responded to treatment but subsequently died outside the hospital. No cause of death is given; was this associated with the chest infection (noting that she was discharged with a tracheostomy in place (lines 142-143) implying some residual respiratory disfunction) or from the underlying morbidities identified in the case (lines 123-124), or from some other cause? - In the abstract this is described as the 'first case of nosocomial pneumonia...' however in the discussion (lines 159-172) it is clear that ventilator-associated pneumonia (which is therefore nosocomial in origin) has been reported for Aeromonas species. …
Comments to Author
Description of the case - The case is described reasonably clearly, and the course of the disease process is clear to follow. The abstract and case description show that the patient responded to treatment but subsequently died outside the hospital. No cause of death is given; was this associated with the chest infection (noting that she was discharged with a tracheostomy in place (lines 142-143) implying some residual respiratory disfunction) or from the underlying morbidities identified in the case (lines 123-124), or from some other cause? - In the abstract this is described as the 'first case of nosocomial pneumonia...' however in the discussion (lines 159-172) it is clear that ventilator-associated pneumonia (which is therefore nosocomial in origin) has been reported for Aeromonas species. Nosocomial Aeromonas hydrophila pneumonia has been previously reported (Baddour & Baselski, South Med J. 1988; 81: 461-3; Plotkin & Scinico, Pa Med. 1986; 89: 40-1) - these are old references and the authors may have thought that the isolate identifications may be questionable now when compared with updated routine laboratory methods. Could the authors address the fact that this is not the first description therefore of nosocomial pneumonia? - Several risk factors are reported in the literature. To what extent were these risk factors present in this case, for example how immunocompromised was the patient as a consequence of the chronic renal disease, was there any e.g. liver, cardiovascular, cerebrovascular, or chronic lung diseases, cancer, MS, (Baddour & Baselski, 1988; Chao et. al., Eur J Clin Microbiol Infect Dis. 2013; 32: 1069-75; Mukhopadhyay et. al. Yonsei Med J. 2003; 44: 1087-90)? - What treatment was given for the Pseudomonas aeruginosa and Klebsiella pneumoniae (lines 131-132); could there have been selective pressure from this treatment to allow the Aeromonas infection to emerge? - How confident was the MALDI-TOF identification for the isolate (line 192-193)? Is this a commonly encountered organism in this laboratory or was any additional testing performed to confirm the identification? - The isolate is reported as pan-sensitive and as resistant to colistin (lines 135-136); what is 'pan-sensitive' in this context? Current EUCAST breakpoints list only 6 agents for which specific breakpoints are available; CLSI M45 (2016) list more agents. What susceptibility testing method was used? Is there any MIC data available? Why was ciprofloxacin selected as the agent of choice? How the style and organization of the paper communicates and represents key findings - The organisation of the paper is generally clear, however the discussion section does merge pathogenicity factors, antimicrobial susceptibilities, and clinical features into a single paragraph (lines 173-183) and I did think that this may have been improved by converting into separate paragraphs. I would have liked to have seen more discussion of risk factors for the acquisition and treatment outcomes for Aeromonas pneumonia. - There are occasions where the paper switches between post and present tenses when describing the clinical course; this can be corrected prior to publication. Aeromonas and other species names need italicising; again this can be corrected prior to publication. 4. Literature analysis or discussion - A Pubmed search for 'Aeromonas hydrophila pneumonia' reveals a number of case reports and series which have not been referenced by the authors. These include nosocomial as well as community acquired infections, and together show a number of patient risk factors. I think this paper could be strengthened by incorporating some of these additional references, highlighting where appropriate how this case adds to the literature.
Please rate the quality of the presentation and structure of the manuscript
Satisfactory
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Thank you very much for submitting your manuscript to Access Microbiology. It has now been reviewed by three experts, who have recommended a number of changes and suggestions. Please pay special attention to those recommending title changes, improvements to the Discussion section and updates in the bibliography. The reviewers have pointed out other previous cases of Aeromonas infections in the literatures, which will have to be considered and worth mentioned in this report.
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Comments to Author
The title can be amended by deleting the word "first case". Though uncommon, instances of Aeromonas in VAP cases are reported, e.g., Microbiological profile of ventilator-associated pneumonia among intensive care unit patients in tertiary Egyptian hospitals, J Infect Dev Ctries 2020; 14(2):153-161. doi:10.3855/jidc.12012. The pictorial description of microorganism and infection control aspects are not discussed and no clinical message is being conveyed by the manuscript. These aspects can be looked into.
Please rate the quality of the presentation and structure of the manuscript
Satisfactory
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other …
Comments to Author
The title can be amended by deleting the word "first case". Though uncommon, instances of Aeromonas in VAP cases are reported, e.g., Microbiological profile of ventilator-associated pneumonia among intensive care unit patients in tertiary Egyptian hospitals, J Infect Dev Ctries 2020; 14(2):153-161. doi:10.3855/jidc.12012. The pictorial description of microorganism and infection control aspects are not discussed and no clinical message is being conveyed by the manuscript. These aspects can be looked into.
Please rate the quality of the presentation and structure of the manuscript
Satisfactory
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
-
Comments to Author
Thank you very much for preparing this case report, it is a good clinical case. i have these question: Did you carry out an ecological study to identify if there was any isolation of aeromones in the instruments/ventilator parts used on the patient? Did you have other cases of VAP due to aeromonas in the ICU referred in the article?
Please rate the quality of the presentation and structure of the manuscript
Very good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript …
Comments to Author
Thank you very much for preparing this case report, it is a good clinical case. i have these question: Did you carry out an ecological study to identify if there was any isolation of aeromones in the instruments/ventilator parts used on the patient? Did you have other cases of VAP due to aeromonas in the ICU referred in the article?
Please rate the quality of the presentation and structure of the manuscript
Very good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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