Emerging challenge of Linezolid and Vancomycin resistant Enterococci faecium:First case report from Northern Pakistan
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Enterococcus faecium are among the most versatile pathogens found to infect hospitalized patients. Resistance against anti-enterococcal antibiotics is gaining access day to day and among them linezolid resistant vancomycin resistant Enterococcus faecium are a nightmare for the clinicians especially in a resource limited country. A 72year old patient presented with collection of pus and necrosis around the head of pancreases. These pockets of pus resulted as acute postsurgical complication along with surgical site infection. Pus was processed according to clinical guidelines Enterococcus faecium was identified and confirmed by VITEK. Isolate was resistant to vancomycin and linezolid. Tigecyclin was the only option for this patient due to unavailability of quinupristin/dalfopristin as a treatment option. A regular follow up was done and patient was discharged after recovery. LRVRE is the result of non-implementation of antimicrobial stewardship and it can be followed with further resistance in Enterococcus which can be havoc. Clinicians infection control team and microbiologist should work together to overcome antimicrobial resistance crises.
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Unfortunately, major language issues still negatively impact the readability and clarity of the manuscript. As this manuscript has already been through two rounds of revision and this issue has still not been satisfactorily resolved, I am not comfortable moving forward with publication or additional rounds of revision at this time.
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Thank you for submitting your revised manuscript. However, there are still several major issues that require attention before this submission can be considered suitable for publication. Please be sure to act on all of the following points to ensure a smooth and fast editorial process upon resubmission. - The language used throughout the manuscript is poor and, as pointed out by both reviewers, needs careful proofreading, ideally by a native or fluent English speaker. We offer a discounted translation service, Editage (https://www.editage.com/; see https://www.microbiologyresearch.org/prepare-an-article#13 for more information), if assistance is needed. - The added pictures of laboratory results are not acceptable in lieu of tables. The images contain identifying patient information and present obstacles for readability. Please convert …
Thank you for submitting your revised manuscript. However, there are still several major issues that require attention before this submission can be considered suitable for publication. Please be sure to act on all of the following points to ensure a smooth and fast editorial process upon resubmission. - The language used throughout the manuscript is poor and, as pointed out by both reviewers, needs careful proofreading, ideally by a native or fluent English speaker. We offer a discounted translation service, Editage (https://www.editage.com/; see https://www.microbiologyresearch.org/prepare-an-article#13 for more information), if assistance is needed. - The added pictures of laboratory results are not acceptable in lieu of tables. The images contain identifying patient information and present obstacles for readability. Please convert the relevant laboratory results into tables and remove identifying information. - The authors' response to reviewer 1 in relation to consideration of polymicrobial infections and follow-up CT scans should be included in the main text. - Reviewer 2 requested additional information on what measures were taken to prevent within-hospital spread of this patient's infection. This was not addressed in the response to reviewers or in the revised submission. Please respond and include this information in the main text.
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The reviewers have highlighted major concerns with the work presented. Please ensure that you address their comments.
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Comments to Author
The authors' motivation for writing this case report is apt considering the emerging threat of antimicrobial-resistant infections in clinical settings. However, there are major concerns that must be addressed. The overall sentence structure of the report is convoluted, making it problematic to follow the main argument. Additionally, there are major grammatical errors and inconsistencies. To improve readability, I would strongly recommend that the report is reviewed by a professional editor or proofreader. Clear and effective writing is paramount in scientific writing and can greatly improve the quality of a report. A case report involving human subjects should include an ethical considerations section to ensure research was conducted in accordance with compliance guidelines. The title of the report …
Comments to Author
The authors' motivation for writing this case report is apt considering the emerging threat of antimicrobial-resistant infections in clinical settings. However, there are major concerns that must be addressed. The overall sentence structure of the report is convoluted, making it problematic to follow the main argument. Additionally, there are major grammatical errors and inconsistencies. To improve readability, I would strongly recommend that the report is reviewed by a professional editor or proofreader. Clear and effective writing is paramount in scientific writing and can greatly improve the quality of a report. A case report involving human subjects should include an ethical considerations section to ensure research was conducted in accordance with compliance guidelines. The title of the report should be revised given that emerging denotes the growth in strength or incidence, yet the authors declare that this is the first case report of vancomycin and linezolid-resistant Enterococcus faecium in Pakistan. The literature review in the introduction section is limiting and I recommend its revision to adequately and concisely address the published literature. This section should include the incidence and importance of VRE worldwide and locally, the impact on patient outcome and the treatment shortcomings. The case presentation structure is satisfactory but some inconsistencies in upper case usage and units can be found. The authors state that the patient improved following administration of tigecycline and further information about dosage and course of treatment is required. In the discussion section, authors must clarify what VanD stands for and detail which precautions were taken to prevent the spread of the reported infection to other hospitalised patients. The authors' motivation for writing this case report is apt considering the emerging threat of antimicrobial-resistant infections in clinical settings. However, there are major concerns that must be addressed. The overall sentence structure of the report is convoluted, making it problematic to follow the main argument. Additionally, there are major grammatical errors and inconsistencies. To improve readability, I would strongly recommend that the report is reviewed by a professional editor or proofreader. Clear and effective writing is paramount in scientific writing and can greatly improve the quality of a report. The title of the report should be revised given that emerging denotes the growth in strength or incidence, yet the authors declare that this is the first case report of vancomycin and linezolid-resistant Enterococcus faecium in Pakistan. The literature review in the introduction section is limiting and I recommend its revision to adequately and concisely address the published literature. This section should include the incidence and importance of VRE worldwide and locally, the impact on patient outcome and the treatment shortcomings. The case presentation structure is satisfactory but some inconsistencies in upper case usage and units can be found. The authors state that the patient improved following administration of tigecycline and further information about dosage and course of treatment is required. In the discussion section, authors must clarify what VanD stands for and detail which precautions were taken to prevent the spread of the reported infection to other hospitalised patients.
Please rate the quality of the presentation and structure of the manuscript
Very poor
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?
No: Ethical considerations are unclear in the report. There is a sentence referring to patient consent but no further information about this study following the relevant regulations and guidelines.
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Comments to Author
I would like to present my gratitude to the authors of this case report manuscript entitled "Emerging challenge of Linezolid and Vancomycin resistant Enterococci faecium: First case report from Northern Pakistan". However, some comments and remarks need to be addressed. - Despite the good work presented in this manuscript, it really needs rewriting from the abstract to the conclusion. Please consult an English editing center to mitigate this limitation. - Organism names in Latin should be italic. - Full form terms should be written at least once before using the abbreviation. - The citation should be included within or at the end of the sentence, not after the period [.]. - Ethical approvals are missing. - Please add tables denoting the blood work of the patient and the resistance profile of …
Comments to Author
I would like to present my gratitude to the authors of this case report manuscript entitled "Emerging challenge of Linezolid and Vancomycin resistant Enterococci faecium: First case report from Northern Pakistan". However, some comments and remarks need to be addressed. - Despite the good work presented in this manuscript, it really needs rewriting from the abstract to the conclusion. Please consult an English editing center to mitigate this limitation. - Organism names in Latin should be italic. - Full form terms should be written at least once before using the abbreviation. - The citation should be included within or at the end of the sentence, not after the period [.]. - Ethical approvals are missing. - Please add tables denoting the blood work of the patient and the resistance profile of the etiologic agent. As well as any radiographic evidence (e.g. x-ray, CT-scan...etc). - How did you rule out polymicrobial infection? - Did you perform a follow up CT-scan after the treatment, to confirm the resolution? - This work would benefit from a molecular analysis to determine the resistance genes for vancomycin and linezolid. All the best.
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?
No: Missing Ethical approval and patient consent
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