Bacteriological profile of community peritonitis operated in a Moroccan Hospital
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Introduction. Peritonitis is characterized by acute inflammation of the peritoneum, often resulting from digestive organ perforation or intra-abdominal septic focus. It may be either of infectious or noninfectious origin. The germs involved are those of the digestive flora (Enterobacteriaceae and Anaerobic), while gram-positive cocci and yeasts can be isolated in nosocomial infections. Our study aims to isolate and identify the germs involved in community-acquired peritonitis, in order to assess their susceptibility to the antibiotics available in our Country. Methods. This is a retrospective study of bacteriological profile of community peritonitis in Rabat Morocco. A total of 150 adult patients with peritonitis, were admitted and samples were collected intraoperatively for bacteriological examination between July 1, 2022 and April 30, 2023. Results. Among the 150 patients, 101 (67.8%) were males and 48 (32.2%) were females, with sex/ratio of 2.1. The mean age of the patients was 40.5 years +/- 20.12. The distribution of germs was dominated by Escherichia coli (44%). Overall, 70% of Escherichia coli isolated, had a resistance to Ampicillin but no resistance to Ampicillin has been reported by Enterococcus. Discussion. In the present study, we were interested in the bacteriological profile of community peritonitis, in order to adapt the antibiotic therapy to our bacterial ecology. Our findings indicate a concerning trend of increasing resistance among Escherichia coli to the commonly used Amoxicillin/Clavulanic Acid combination in our clinical setting. Conclusion. Consequently, there is a need to reassess the empiric antibiotic prescribed for the management of community-acquired peritonitis.
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All reviewer and editor comments have been sufficiently addressed.
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Author responses to reviewer and editor concerns are acceptable. However, several of the explanations provided were not added to the text. Please revise the manuscript and incorporate the information that was shared in the responses to review comments. This includes (1) what factors were observed during macroscopic examination, (2) that "positive" samples indicate bacterial peritoneal infection, and (3) how antibiotic resistance rate was calculated.
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Thank you for your submission to Access Microbiology. After peer review, editor and reviewer concerns about the presentation, methodology, and logic for the presented study have been raised. While there is some valuable data, such as updated data on antibiotic resistance since the last known study of similar methodology in this region, the manuscript in its current format is very weak and does not convey its findings efficiently. Please be sure to address all editor and reviewer comments in revising the manuscript for resubmission. - The use of "germs" as a general term throughout the manuscript is a poor choice that would be better replaced with another term such as "bacteria," as no viruses or fungi were included in the presented study. - Grammatical and language errors persist throughout the manuscript. It is highly recommended that …
Thank you for your submission to Access Microbiology. After peer review, editor and reviewer concerns about the presentation, methodology, and logic for the presented study have been raised. While there is some valuable data, such as updated data on antibiotic resistance since the last known study of similar methodology in this region, the manuscript in its current format is very weak and does not convey its findings efficiently. Please be sure to address all editor and reviewer comments in revising the manuscript for resubmission. - The use of "germs" as a general term throughout the manuscript is a poor choice that would be better replaced with another term such as "bacteria," as no viruses or fungi were included in the presented study. - Grammatical and language errors persist throughout the manuscript. It is highly recommended that the authors have a native English speaker aid in revising the submission. Alternatively, we offer a discounted translation service, Editage (https://www.editage.com/; see https://www.microbiologyresearch.org/prepare-an-article#13 for more information). Please note that submissions that do not correct poor language usage and remain difficult to read and understand after multiple rounds of revision may be issued a decision of no longer under consideration for publication. - The authors state that patients under the age of 15 were excluded from the study. Please explain this choice (i.e. Why 15 rather than 18? Are younger populations known to have key differences in GI health that would impact the study?) - Please clarify what is meant by "macroscopic examination" of samples. - Please expand on the methods used to identify bacterial species from samples. A general statement that "conventional bacteriological methods" was used is not sufficient. - In lines 93-94, authors state that 162 of the received samples were "positive." What were these samples positive for? - Authors state that there were 150 patients included in the study, of which 101 were male and 48 were female. These numbers add up to 149. Were only 149 patients included or is there another patient unaccounted for in the provided numbers? - Figure 2 needs a label for the y-axis. - Why was E. faecalis given its own antibiotic resistance figure (Figure 3)? This decision needs justification in the text or the data shown in Figure 3 need to be incorporated into Figure 2. If Figure 3 is kept, it also needs a label for its y-axis. - Please clarify what "resistance rate" means and how it was calculated (What assay was used? What measurements were used to calculate resistance rates as percentages?). - In the discussion, the authors mention unstable hygienic conditions as a possible reason for the average patient age seen in this study. Please explain how these factors relate (i.e. Wouldn't hygienic conditions affect all ages of patients?) or remove this statement. - Similarly, authors state that they observed a male predominance in the presented study, which is a trend other studies have seen. This is portrayed as somewhat of a a pseudo-conclusion, and either needs removal/rephrasing to clarify that this is simply an observation or more clarification and references explaining why males may present with peritonitis at higher rates than female patients.
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Comments to Author
- In the results section the distribution of germs showed Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae and Pseudomonas aeruginosa, while in figure 2 the organisms mentioned include E.coli, Klebsiella pneumoniae, proteus mirabilis and Enterobacter cloacae. - In the antibiotic resistance profile of Proteus mirabilis the antibiotic resistance to ceftriaxone is 0% while to imipenem is 8%! - In figure 2 the antibiotic nalidixic acid is written as AN while in the figure legend is written as AN. - In figure 3: Erythromycin and rifampin have no role in treatment of enterococcal peritonitis. - The protocols mentioned in the discussion for treatment of peritonitis are so old: reference number 4 (2005) and number 15 (2011) and these protocols are no longer applied nowadays due to the growing …
Comments to Author
- In the results section the distribution of germs showed Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae and Pseudomonas aeruginosa, while in figure 2 the organisms mentioned include E.coli, Klebsiella pneumoniae, proteus mirabilis and Enterobacter cloacae. - In the antibiotic resistance profile of Proteus mirabilis the antibiotic resistance to ceftriaxone is 0% while to imipenem is 8%! - In figure 2 the antibiotic nalidixic acid is written as AN while in the figure legend is written as AN. - In figure 3: Erythromycin and rifampin have no role in treatment of enterococcal peritonitis. - The protocols mentioned in the discussion for treatment of peritonitis are so old: reference number 4 (2005) and number 15 (2011) and these protocols are no longer applied nowadays due to the growing problem of antimicrobial resistance both in the hospital and community settings.
Please rate the manuscript for methodological rigour
Satisfactory
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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Comments to Author
This paper investigated the microbial profile of community acquired peritonitis and the related antibiogram. Many issues are raised for authors to respond: -Why authors selected community-acquired infection. The work-up has been conducted in the hospital. Investigating nosocomial infections (any type) seems more significant and it has many benefits for caring admitted patients. Please justify -What is the method for AST? please clarify -What about anaerobes/fungal pathogens. Although authors used media for isolation, results did not show their isolation rate> If no isolation of these pathogens, what is your explanation. It is very common to isolate anaerobes/or fungi from peritonitis.
Please rate the manuscript for methodological rigour
Poor
Please rate the quality of …
Comments to Author
This paper investigated the microbial profile of community acquired peritonitis and the related antibiogram. Many issues are raised for authors to respond: -Why authors selected community-acquired infection. The work-up has been conducted in the hospital. Investigating nosocomial infections (any type) seems more significant and it has many benefits for caring admitted patients. Please justify -What is the method for AST? please clarify -What about anaerobes/fungal pathogens. Although authors used media for isolation, results did not show their isolation rate> If no isolation of these pathogens, what is your explanation. It is very common to isolate anaerobes/or fungi from peritonitis.
Please rate the manuscript for methodological rigour
Poor
Please rate the quality of the presentation and structure of the manuscript
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: Authors should clearly mention that the study follows Helsinki Declaration. The study did not include institutional approval or informed patients consent
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After review of the initial manuscript, there are concerns about incomplete compliance with Access Microbiology's open data policy. The manuscript contains a data summary statement that no data was generated during this research. However, the manuscript includes patient demographic data and antibiotic susceptibility data for several bacterial species that have not been previously published. Please view the platform's open data policy (https://www.microbiologyresearch.org/open-data) and deposit the raw data used to generate the figures in this manuscript in a repository; several repository options are listed on the open data policy page.
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