Evaluation of antimicrobial pattern of difficult-to-treat resistant Gram negative bacteria from pus samples in a tertiary care setting
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Skin and skin structure infections are one of the leading causes of difficult to treat infections. Knowledge about antimicrobial susceptibility and resistance patterns of the isolates yielded from pus specimens will help in efficient and effective management of patients. The aim of our study was to determine the aerobic bacteriological profile from various types of skin and skin structure infections and the susceptibility pattern of difficult-to-treat resistant Gram negative bacteria isolated from pus specimens. This was a retrospective study conducted in Pak Emirates Military Hospital department of microbiology, Army Medical College (National University of Medical Sciences) Rawalpindi. Data of 1,250 pus specimens from January 2023 to December 2023 was retrieved from hospital management system. Pus was processed according to standard microbiological procedure and antimicrobial susceptibility was determined following Clinical and Laboratory Standards Institute 2023.Data was analyzed using statistical package for social sciences version 26 and p value was calculated. Descriptive factors (frequencies, percentage) were calculated for the socio demographic characteristics and antibiotic susceptibility was determined. P value of less than or equal to 0.05 was taken as significant. A total of 1,250 pus specimens were received during one year. Out of these 416 (33.2%) were Gram negative rods and 356 (28.4%) were Gram positive cocci. The most frequently isolated organism was Escherichia coli 156(30.3%) followed by Klebsiella pneumoniae and Pseudomonas aeruginosa. Acinetobacter baumannii emerged as the most resistant pathogen. It was resistant to all antimicrobials except colistin and tigecycline. This study has enabled us to determine various types of Gram negative rods present in pus specimens, as well as their sensitivity for different antibiotics. This information will be used to create our institutional antibiogram, which will guide clinicians in making valuable treatment decisions. Additionally, this study highlights the importance of effective infection control and prevention practices in a large hospital setting, which can help prevent antimicrobial resistance and promote optimal patient care.
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Thank you for your response to the initial editorial requirements. Following further assessment, we would still require the following changes before we can proceed with review. As an Open Data Platform, please provide evidence of the data you gathered for this study. This can be a set of example images for the Gram stains, exemplars of each morphology you identified and the API data. API data could be a table for example. Additionally please clarify the use of 'Social science package' for data analysis and further clarify where you use these statistics and why. Please let me know if you have any questions and we happy to discuss. If you can satisfy these comments, we would be happy to proceed to peer review.
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I have several issues regarding your manuscript especially about the methodology section 1. your Retrospective study limits the capability for the variables confounding and it may present the biasness in the data collection 2. the data collection has been placed in a single center which may effect the general aspect of the observations regarding the other populations 3. The author must have clarify and justify the size of the sample collection that why 1250 sample? is it suitable for the objectives of the current study 4. what is the Exclusion criteria for the current study? why repeat specimen from the same patient is excluded? 5. no detail description for the bacterial identification, such as PCR or any specific gene identification? 6. missing information regarding the quality control? such as identification methods and susceptibility …
I have several issues regarding your manuscript especially about the methodology section 1. your Retrospective study limits the capability for the variables confounding and it may present the biasness in the data collection 2. the data collection has been placed in a single center which may effect the general aspect of the observations regarding the other populations 3. The author must have clarify and justify the size of the sample collection that why 1250 sample? is it suitable for the objectives of the current study 4. what is the Exclusion criteria for the current study? why repeat specimen from the same patient is excluded? 5. no detail description for the bacterial identification, such as PCR or any specific gene identification? 6. missing information regarding the quality control? such as identification methods and susceptibility testing? 7. incomplete statistical analysis 8. lack of information on the pattern of antibiotic usage at hospital, which could influence the resistance pattern 9. the author mentioned the partial pathogenic scope such as only regarding the bacterial source while fungal infection has been avoided 10. current study was conducted in 2024 while data has been collected in 2023 the author may have to justify the time discrepancy 11. the author did not include the patient consent for the data usage 12. the author did not include the data whether the resistance pattern change over the time 13. the author did not explore about the statement regarding the tigecycline promising results for their support 14. the author did not mentioned about the patient treatment outcome. 15. the author may have to add MIC for the said antibiotics
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