Indwelling central venous catheter infection with Chryseobacterium shandongense – successful eradication in a 5-year-old with cystic fibrosis
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Introduction. Chryseobacterium shandongense is a Gram-negative Flavobacterium bacillus with intrinsic multidrug-resistant properties.
Case Presentation. Herein, we present the first case report of human C. shandongense infection, relating to an implantable portal and catheter (port-a-cath) central line in a 5-year-old female with cystic fibrosis. The infection was identified using a Bruker MALDI-TOF Biotyper with BDAL (v12) of blood, which was cultured due to pyrexia and rigour following port-a-cath access. This report details the effective eradication of C. shandongense infection from the port-a-cath device using initial empirical gentamicin followed by targeted ciprofloxacin locks and systemic antibiotics.
Conclusion. We demonstrated successful eradication of C. shandongense from a port-a-cath device, including the minimum inhibitory concentrations (MICs) required in this case. The result was eradication of central access infection, preventing progression to bacteraemia/septicaemia and preserving central access in a child with cystic fibrosis and established respiratory disease.
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This study would be a valuable contribution to the existing literature. This is a study that would be of interest to the field and community.
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This study would be a valuable contribution to the existing literature. The reviewers have highlighted minor concerns with the work presented. Please ensure that you address their comments.
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Comments to Author
1. Description of the case(s) Interesting case report describing the first reported case of a Chryseobacterium shandongense line infection in a Cystic fibrosis patient. 2. Presentation of results A case report therefore no results. However the antibiotic sensitivities are unclear. The MICs are demonstrated in the body of the text but it is unclear what the interpretation of the MICs are i.e. are they susceptible/resistant/susceptible at increased dose. This could be demonstrated in a table format. 3. How the style and organization of the paper communicates and represents key findings The paper is appropriately split into introduction, case report and discussion helping to delineate each part. Regarding the events occurrence I would keep this chronologically or create a timeline of events as there is …
Comments to Author
1. Description of the case(s) Interesting case report describing the first reported case of a Chryseobacterium shandongense line infection in a Cystic fibrosis patient. 2. Presentation of results A case report therefore no results. However the antibiotic sensitivities are unclear. The MICs are demonstrated in the body of the text but it is unclear what the interpretation of the MICs are i.e. are they susceptible/resistant/susceptible at increased dose. This could be demonstrated in a table format. 3. How the style and organization of the paper communicates and represents key findings The paper is appropriately split into introduction, case report and discussion helping to delineate each part. Regarding the events occurrence I would keep this chronologically or create a timeline of events as there is some jumping around which can be confusing to read ie Porta cath placed 2022, then PEG placed in 2019, admitted in 2023. 4. Literature analysis or discussion The literature review cover relevant papers. The discussion fails to mention why the team decided to try and salvage the line rather than just remove it. I appreciate the patient needs frequent antibiotics but I think it would be worth commenting on the clinical rationale of the decision. 5. Any other relevant comments There are spelling errors throughout the paper related to the primary organism. The organism varies between shandogenes or shandongenes, however when reviewing other literature I believe the organism is actually named Chryseobacterium shandongense. Therefore this will need changed throughout the manuscript including in the title. Please also avoid the use of abbreviations unless this is described or explained within the text ie. Line 45 people with CF (pWCF). It is the first time mentioning CF and therefore should be written as Cystic Fibrosis (CF). There should also be terminology consistency ie Chyrseobacterium spp, Chyrseobacterium species & C.spp all get used interchangeably throughout. With regards to the MICs used, there is no indication where these breakpoints are from as I believe there are no EUCAST or CLSI Chyrseobacterium spp breakpoints. I note other papers have used both Pseudomonas and non Enterobacteriaceae breakpoints. I would clarify which breakpoints were used and rationale behind this. Microbiological images of growth on agar or microscopy would also be useful as this is the first case report of a line infection. There are some other small amendments I would suggest which helps to clarify ambiguity. Line 63 mentions that the patient was 'admitted empirically'. I presume they were admitted for empirical antibiotics and were either admitted electively or as an emergency. Can this please be clarified? Line 66/67 it is written that blood cultures were taken 'peripherally and centrally.' It is never specifically mentioned that cultures were taken from the port-a-cath. As this is the crux of the paper I would specifically mention this. Line 91/92 states that Chryseobacterium was not grown in the sputum. Was any other bacteria grown and in the context of her CF and recurrent chest infections was this treated/influence the clinical course? Line 101/102. The discussion mentions that treatment was for 2 weeks but I think this should be stated in the case report itself. Also clarify regarding which antibiotics were given for this duration
Please rate the quality of the presentation and structure of the manuscript
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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Comments to Author
The manuscript entitled" Indwelling central venous catheter infection with Chryseobacterium shandongenes, successful eradication in a five-year-old with Cystic Fibrosis" by Anthony Rowan et al. describes the successful diagnosis and eradication of C. shandongenes infection of an implantable portal and catheter device in a five-year-old female patient with cystic fibrosis. The case presentation is interesting, however, some concerns should be considered. My comments are listed as follows: 1- In line 40, please cite the relevant references for "There are limited reports of Chryseobacterium spp infection and human pathogenesis." 2- The sentences should begin with complete words, not abbreviations; for the name of bacteria, please write the complete form ( genus and species ) at the beginning of the …
Comments to Author
The manuscript entitled" Indwelling central venous catheter infection with Chryseobacterium shandongenes, successful eradication in a five-year-old with Cystic Fibrosis" by Anthony Rowan et al. describes the successful diagnosis and eradication of C. shandongenes infection of an implantable portal and catheter device in a five-year-old female patient with cystic fibrosis. The case presentation is interesting, however, some concerns should be considered. My comments are listed as follows: 1- In line 40, please cite the relevant references for "There are limited reports of Chryseobacterium spp infection and human pathogenesis." 2- The sentences should begin with complete words, not abbreviations; for the name of bacteria, please write the complete form ( genus and species ) at the beginning of the sentence. For example, in line 45, please replace "Chryseobacterium shandongenes" instead of "C. shandogenes". 3- In line 48, the author mentioned," Infections associated with C. spp are described…" What is the meaning of C.spp. please correct this section. 4- In line 67, the authors mentioned:" blood cultures were collected centrally". Please add the information on the method of culturing " BACTEC. The type of bottle? Also, the variety of media for culture. 5- In line 71, the author mentioned," Following 29 hours of incubation," please write the incubator's temperature. 6- I suggest the author add a table and list the Cases of infections caused by Chryseobacterium shandongenes reported in the literature ( age, gender, type of infection, Country, Underlying condition, predisposing factors, treatment regime, and outcomes.
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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