Trends and antibiotic susceptibility patterns of diarrhoeal pathogens – experience over 14 years in southern India
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Introduction . Enteric pathogens contribute significantly to morbidity in a developing country such as India. Early and prompt diagnosis of diarrhoeal diseases can reduce the mortality rate, particularly in children. The pattern of sensitivity to antimicrobials for the common pathogens can vary from time to time. The present study was conducted to study the pathogen distribution and antimicrobial susceptibility pattern during the study period (January 2010 to December 2023).
Hypothesis/gap statement . Studying the changing trend in the antimicrobial sensitivity pattern of diarrhoeal pathogens over a decade can help to plan future treatment options.
Aim . This study was undertaken to provide insights into the changing pattern of pathogen distribution and antimicrobial susceptibility for enteric pathogens over 14 years.
Methods . A retrospective observational cohort analysis was conducted on all the stool pathogens isolated from the samples received in the microbiology department of a tertiary care hospital from 2010 to 2023. The demographic details, stool microscopy, culture reports, and antimicrobial susceptibility patterns were noted.
Results . A total of 18 336 stool specimens were received in the microbiology laboratory between January 2010 and December 2023, of which 1354 specimens had diarrhoeal pathogens grown in culture. Out of these 1354 specimens, 591 (44%) had Salmonella , 471 (35%) Shigella , 181 (13%) Vibrio cholerae, and 80 (6%) Aeromonas species. Among these pathogens, susceptibility to ceftriaxone was seen in 93% (552 isolates) of Salmonella species, 89% (420 isolates) of Shigella species, and 95% (171 isolates) of Vibrio cholerae ; 91% (73 isolates) of Aeromonas species were susceptible to chloramphenicol. Some major parasites were also observed on microscopy.
Conclusion . Timely diagnosis of diarrhoeal pathogens can be life-saving for patients at the extremes of age, i.e. in children and the elderly. Pathogens can exhibit a changing susceptibility pattern to antibiotics, which should be regularly observed to plan future therapy.
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Dear Dr Mandal, Thank you for your submission and revisions. I'm happy to say that manuscript has now been accepted. We hope you will consider ACMI again in the future. Best wishes, John.
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Comments to Author
kindly check that all microorganisms' are written in italics.
Please rate the manuscript for methodological rigour
Good
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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Please rate the manuscript for methodological rigour
Good
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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Dear Jharna Mandal, Thank you for your submission, I have selected minor amendments following reviews. Please address comments where possible. To expand on certain comments: Reviewer 1, lines 48-51. Please represent these numbers e.g. 111/222 (50%). This will make it clearer to read. Reviewer 2, i recommend you perform the statistical analysis requested or similar. 65 Best wishes, John.
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Comments to Author
1. Regarding serogrouping of E. coli and S. typhi, methods used for serogrouping should be mentioned. 2. Confirmation of pathogen identification either genotypically or phenotypically should be added. 3. In general, paper should be revised for English grammar and structure. 4. Regarding antibiogram, more antibiotics representing different classes of antibiotics should be included. 5. To perform sensitivity analyses, several modified Poisson regression models are recommended to be performed to assess the robustness of the primary analysis before secondary analyses. 6. The Kruskal-Wallis test is recommended used to determine significant differences in median ages and Fisher's exact test to determine significant differences in proportions. 7. updated references are to be included in discussion section …
Comments to Author
1. Regarding serogrouping of E. coli and S. typhi, methods used for serogrouping should be mentioned. 2. Confirmation of pathogen identification either genotypically or phenotypically should be added. 3. In general, paper should be revised for English grammar and structure. 4. Regarding antibiogram, more antibiotics representing different classes of antibiotics should be included. 5. To perform sensitivity analyses, several modified Poisson regression models are recommended to be performed to assess the robustness of the primary analysis before secondary analyses. 6. The Kruskal-Wallis test is recommended used to determine significant differences in median ages and Fisher's exact test to determine significant differences in proportions. 7. updated references are to be included in discussion section representing results in India and worldwide.
Please rate the manuscript for methodological rigour
Poor
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
This study ACMI-D-2400071 Title: Trends and antibiotic susceptibility patterns of diarrhoeal pathogens - an experience of fourteen years in Southern India. This study was undertaken to provide insight into the changing pattern of pathogen distribution and antimicrobial susceptibility of enteric pathogens over 14 years. This is a good and publishable study, within the scope of the ACMI but needs minor corrections. Abstract lines 48-51. Authors need to include the whole number with percentages instead of just whole number which can be confusing. Line 51. Authors are advised not to start a sentence with a whole number, rather start with a total of….., this should apply to the whole manuscript. Introduction This section lacks basic literature the subject of diarrhoeal pathogens and the currently …
Comments to Author
This study ACMI-D-2400071 Title: Trends and antibiotic susceptibility patterns of diarrhoeal pathogens - an experience of fourteen years in Southern India. This study was undertaken to provide insight into the changing pattern of pathogen distribution and antimicrobial susceptibility of enteric pathogens over 14 years. This is a good and publishable study, within the scope of the ACMI but needs minor corrections. Abstract lines 48-51. Authors need to include the whole number with percentages instead of just whole number which can be confusing. Line 51. Authors are advised not to start a sentence with a whole number, rather start with a total of….., this should apply to the whole manuscript. Introduction This section lacks basic literature the subject of diarrhoeal pathogens and the currently used antimicrobials that are available, this makes the introduction section to be very scanty and not easy to extract the importance of the analysis, therefore, this manuscript needs to be refined. Method In the data collection section Line 85-…authors need to clarify how exactly the data was retrospectively collected from the medical records, this may not completely reflect the actual data collection as one would expect Microbiological data to be collected from the Laboratory Information System or database etc, instead of medical records. Also, maybe it'll a great help to include where the study was conducted or the study setting as a section on its own. Line 109-.? Line 111-The statistical analysis is not addressed, authors need to indicate how their results were analysed, as well as how the descriptive statistics were carried out for both categorical and numerical variables etc. this section need to be revised. Results and Discussion sections Authors should consistently write all organisms in italics, some of the organisms are still not in italics. Conclusions Authors should consistently write all organisms in italics, some of the organisms are still not in italics. References Consistency in writing organisms in italics
Please rate the manuscript for methodological rigour
Good
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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