Carbapenem-resistant Citrobacter amalonaticus and VRE bacteraemia in an immunocompetent patient after a urological Rezum procedure

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Abstract

In this report, we discuss the case of a 62-year-old man who presented with gross haematuria, fever, and chills 1 day after undergoing a Rezum procedure and was found to have carbapenem-resistant Citrobacter amalonaticus and vancomycin-resistant Enterococcus faecalis bacteraemia. The patient was treated with daptomycin, eravacycline, and ceftalozane–tazobactam with positive results. We discuss our case and treatment of C. amalonaticus bacteraemia, a pathogen with limited existing literature on its incidence, presentation, and treatment.

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  1. Many thanks for your interesting case report. You have addressed the comments from the initial round of reviewers well and your manuscript is very well written. On review by myself, as a different Editor previously handled your work, I do have a few very minor comments that I hope you can address before consideration for acceptance to publication; Line 56 - Consider units for the WBC Line 68 - For consistency, either stick to frequency reporting as q12h and q8h or every 12 hours, every 8 hours. Regarding your interpretative breakpoints, it would be useful to state which guidelines were used, EUCAST? CLSI? Line 74-76 - Your work is very topical given the growing problem of antimicrobial resistance. You stated specifically that NDM and VIM were not present; but no comments was made for OXA or KPC or other Ambler Class resistance genes. Was any phenotypic or genotypic testing done for AmpC or ESBL production? Was the PCR specifically for NDM and VIM and not a "Big-5" Carbapenemase Genes? Was a carbapenem inactivation method (CIM) performed? It would be very important to clarify whether this was merely a carbapenem-resistant organism, as opposed to a carbapenemase-producing one. If none of these were done, it should be mentioned as major limitation. I am happy to be contacted to clarify any of the above.

  2. Comments to Author

    This case presentation although written well in an engaging style. But it does not add any relevant new data to be published in Microbiology Journals.

    Please rate the quality of the presentation and structure of the manuscript

    Good

    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

  3. Comments to Author

    Thanks, interesting case. Few comments on minor typographic issues and a bit of technical detail I think readers would be keen to know about if they were to consider using eravacycline in such a situation. 1. Please add units - degs C and bpm. "55 At presentation, the patient was febrile to 39.3, tachycardic to 110 but otherwise hemodynamically 2. Is this definitely correct? Enterococci should yield GPC in chains, not clusters. "60 Blood cultures originally resulted in gram-negative rods and gram-positive cocci in clusters and of 3. -add word AND "62 admission, blood cultures grew Citrobacter amalonaticus vancomycin-resistant Enterococcus 4. Please add/amend units SI - mg/L for each MIC "65 of 16/4 microgram/mL) but good sensitivity to ceftalozane-tazobactam (MIC

    Please rate the quality of the presentation and structure of the manuscript

    Good

    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