Review Reports - The Pathogenesis, Clinical Features, and Treatment of Corynebacterium striatum-Related Infection

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript “The Epidemiology, Pathogenesis, Clinical features, and Treatment of Corynebacterium striatum Related-infection” I believed will be a significant contribution to the field and I congratulate the authors for the thought provoking discussion of the topic. However, I provided so specific comments in order to improve upon the general quality of the manuscript as well as n the attached documents.

Summary of Comments on Type of the Paper (Article

Page: 1

Line 2: The general presentation of the manuscript did not provide relevant information on epidemiology rather than historical background of C. striatum; which is not enough to claim epidemiology. Therefore, I proposed that epidemiology should be removed from the topic

Line 3: italic the name of the microorganisms throughout

Line 11: put in italic

Line 27: bacillus is should be in italic

Lines 29-31: provide relevant citation

Line 38: it should be “resistant (MDR) microorganisms in intensive care units (ICU) remains high”

Lines 28-29: kindly site this information.

Page: 2

Line 46: Provide the source of the figure.

Lines 56-59: Can you cite the sources of the outbreaks

Author: Subject: Comment on Text Date: 2025/11/17 13:50:14

Lines 62-63: regarding the ------with mechanical ventilation),--- this information need citation.

Page: 3

Lines 70-71: list some of the fungi, bacteria, and viruses by name

Line 78-79: "When co-exists with other bacteria, C. striatum could either attenuate or enhance the 78 virulence of these strains." cite this information. Be careful of plagiarism

Line 82: please present as "Biofilm Synergy: "

Lines 82-87 need relevant citation.

Lines 88-93: this information should be cited. Also, the various mechanism should be presented using schematic diagrams

Table 1: Provide the references against the rows in a new column. I believed you gathered these information from different literature.

Page: 4

Lines 105-112: This information require appropriate citations. This is a review and most of the information are susceptible to plagiarism since these are not the authors' original claims

Line 113: put in italic "C. striatum"

Lines 131-132: recommended methods for what? It should be cited as well.

Page: 5

Lines 144-153: cite the various sources where each of the techniques has been used in typing C. striatum

Table 2: Add a new column to the table 2 and provide citation for each row. These information I believed was gotten from some literature and they must be credited.

Page: 6

Table 3: Add a new column to table 3 and provide citation for each row. These information I believed was gotten from some literature and they must be credited.

Page: 9

Provide relevant citations. Lines 307-311

Page: 10

Lines 319-322: recast and cite the appropriate source.

Lines 324-325: says who?

Comments for author File: Comments.pdf

Author Response

page: 1

Response 1: Thank you for pointing this out. We agree with this comment. Therefore, “epidemiology” had been removed from the topic. The revised manuscript this change can be found page 1, and line 2.

Line 3: italic the name of the microorganisms throughout

Response 2: Thanks, We totally agree with this suggestion. Therefore, “The name of the microorganisms has been put in italic throughout the article” . The revised manuscript this change can be found throughout the article.

Line 11: put in italic

Response 3: We appreciate your review. We agree with this comment. Therefore, “The “striatum” has been put in italic”. The revised manuscript this change can be found page 1, and line 11.

Line 27: bacillus is should be in italic

Response 4: Thank you for pointing this out. We agree with this comment. Therefore, “The “bacillus” has been put in italic” . The revised manuscript this change can be found page 1, and line 27.

Lines 29-31: provide relevant citation

Line 38: it should be “resistant (MDR) microorganisms in intensive care units (ICU) remains high”

Lines 28-29: kindly site this information.

Response 7: Thank you for pointing this out. We agree with this comment. We provided the following citation “Silva-Santana G, Silva CMF, Olivella JGB, et al. Worldwide survey of Corynebacterium striatum increasingly associated with human invasive infections, nosocomial outbreak, and antimicrobial multidrug-resistance, 1976–2020. Archives of Microbiology. 2021;203(5):1863–1880.” The revised manuscript this change can be found page 1, and line 31

Page: 2

Line 46: Provide the source of the figure.

Response 8: Thank you for pointing this out. We revised the figure caption as follows: Corynebacterium striatum-related infections and their risk factors (Created by the authors). The revised manuscript this change can be found page 2, and line 46

Lines 56-59: Can you cite the sources of the outbreaks

Response 9: Your valuable feedback means a lot to us. We agree with this comment. References are provided for each statement. The revised manuscript this change can be found page 2, and line 61.

Author: Subject: Comment on Text Date: 2025/11/17 13:50:14

Lines 62-63: regarding the ------with mechanical ventilation),--- this information need citation.

Response 10: Thanks again for your valuable feedback. We agree with this comment. The catation are provided follows the statement. The revised manuscript this change can be found page 2, and line 66.

Page: 3

Lines 70-71: list some of the fungi, bacteria, and viruses by name

Response 11: We appreciate your review. We agree with this comment. We revised the statment as follows: Reports of C. striatum co-infection with other bacteria, fungi, and viruses were not rare, such as acinetobacter baumannii, aspergillus spp. or pneumocystis jirovecii. The revised manuscript this change can be found page 3, and line 72.

Line 78-79: "When co-exists with other bacteria, C. striatum could either attenuate or enhance the 78 virulence of these strains." cite this information. Be careful of plagiarism

Response 12: Thank you for pointing this out. We agree with this comment. The original text is “When co-exists with other bacteria, C. striatum could either attenuate or enhance the virulence of these strains”. So we put it in other words “When co-existing with other bacterial species, C. striatum can influence their virulence, leading to either attenuation or enhancement”. The revised manuscript this change can be found page 3, and line 81.

Line 82: please present as "Biofilm Synergy: "

Response 13: Thanks again for your valuable feedback. We agree with this comment. We revised the statment as follows: “Biofilm Synergy:”. The revised manuscript this change can be found page 3, and line 84.

Lines 82-87 need relevant citation.

Response 14: Thank you so much. We agree with this comment. We reviesd the expression and added two relevent references in the article. The revised manuscript this change can be found page 3, and line 90.

Lines 88-93: this information should be cited. Also, the various mechanism should be presented using schematic diagrams

Response 15: Thank you for pointing this out. We agree with this comment. We reviesd the expression add relevent references in the article. The revised manuscript this change can be found page 3, and line 90 to 94.

Table 1: Provide the references against the rows in a new column. I believed you gathered these information from different literature.

Response 16: Thank you for pointing this out. We agree with this comment. We annotated the existing references or add some relevent references in the article. The revised manuscript this change can be found page 3, and line 103.

Page: 4

Lines 105-112: This information require appropriate citations. This is a review and most of the information are susceptible to plagiarism since these are not the authors' original claims

Response 17: We appreciate your review. We agree with this comment. We delete some expressions as for the lack of sufficient and strong evidence. The revised manuscript this change can be found page 4, and line 107.

Line 113: put in italic "C. striatum"

Response 18: Thanks again for your valuable feedback. We agree with this comment. We put the "C. striatum" in italic. The revised manuscript this change can be found page 4, and line 111.

Lines 131-132: recommended methods for what? It should be cited as well.

Response 19: Thank you for pointing this out. We agree with this comment. We add the citation in the article. The revised manuscript this change can be found page 4, and line 131.

Page: 5

Lines 144-153: cite the various sources where each of the techniques has been used in typing C. striatum

Response 20: Thanks again for your valuable feedback. We agree with this comment. We add the citation in the article. The revised manuscript this change can be found page 5, and line 145 to 154.

Table 2: Add a new column to the table 2 and provide citation for each row. These information I believed was gotten from some literature and they must be credited.

Response 21: Thank you for pointing this out. We agree with this comment. We add the citation in table 2. The revised manuscript this change can be found page 5, and line 184.

Page: 6

Table 3: Add a new column to table 3 and provide citation for each row. These information I believed was gotten from some literature and they must be credited.

Response 22: We appreciate your review. We agree with this comment. We add the citation in table 3. The revised manuscript this change can be found page 5, and line 191.

Page: 9

Provide relevant citations. Lines 307-311

Response 22: Thank you for pointing this out. We agree with this comment. We add the relevent citation. The revised manuscript this change can be found page 6, and line 316.

Page: 10

Lines 319-322: recast and cite the appropriate source.

Response 23: Thanks again for your valuable feedback. We agree with this comment. We recast the original expression and add the relevent citation. The revised manuscript this change can be found page 6, and line 334.

Lines 324-325: says who?

Response 24: Thanks again for your valuable feedback. We agree with this comment. We recast the original expression and add the relevent citation. The revised manuscript this change can be found page 6, and line 341.

Reviewer 2 Report

Comments and Suggestions for Authors

The manuscript provides a timely and comprehensive overview of Corynebacterium striatum as an emerging multidrug-resistant pathogen. The topic is highly relevant, and the review successfully compiles epidemiological, clinical, microbiological and therapeutic data from a wide range of recent publications. However, the manuscript would benefit from substantial editorial and structural improvements before it can be considered for publication.

My detailed observations:

Numerous grammatical errors, inconsistent sentence structures, and unclear phrasing are present throughout the text (e.g. misuse of plurals, tense inconsistencies, awkward constructions). A thorough revision by a native English editor is required to improve readability.
Several paragraphs are overly long and mix heterogeneous content (e.g., epidemiology interwoven with outcome data, mechanisms mixed with surveillance aspects). Reorganizing these sections into more concise thematic blocks would enhance clarity.
Figure 1 (page 1) shows a schematic overview of infection sites and risk factors, but the illustration is somewhat generic and the resolution is limited. I recommend ensuring a higher-quality image or redrawing it with sharper labels and improved contrast.
Certain epidemiological statements appear multiple times (e.g., mentions of South Korea, ICU outbreaks, community vs. hospital-acquired infections). Consolidation would strengthen the narrative.
The “Molecular subtype” section could integrate a more structured comparison of global ST distributions.
The “Virulent agents” section would benefit from a clearer explanation of how each gene category mechanistically contributes to persistence or clinical outcomes.
The “Treatment” section should elaborate on practical therapeutic challenges (e.g., interpretation of C. striatum in sputum cultures, differentiating colonization vs infection).
References are abundant and up-to-date. However, minor formatting inconsistencies (punctuation, spacing, missing italics) should be corrected to align with MDPI style.
The conclusions are concise but could be strengthened by highlighting specific clinical or research priorities (e.g., standardized breakpoints, improved diagnostics, surveillance harmonization).

Author Response

Numerous grammatical errors, inconsistent sentence structures, and unclear phrasing are present throughout the text (e.g. misuse of plurals, tense inconsistencies, awkward constructions). A thorough revision by a native English editor is required to improve readability.

Response 1: Thank you for pointing this out. We agree with this comment. Numerous grammatical errors have been revised thorough the review and the English writing was improved sentence by sentence.

Several paragraphs are overly long and mix heterogeneous content (e.g., epidemiology interwoven with outcome data, mechanisms mixed with surveillance aspects). Reorganizing these sections into more concise thematic blocks would enhance clarity.

Response 2: Thanks, We agree with this suggestion. these sections have been revised into more concise.

Figure 1 (page 1) shows a schematic overview of infection sites and risk factors, but the illustration is somewhat generic and the resolution is limited. I recommend ensuring a higher-quality image or redrawing it with sharper labels and improved contrast.

Response 3: Thanks, We agree with this suggestion. Figure 1 has been revised into a higher-quality image.

Certain epidemiological statements appear multiple times (e.g., mentions of South Korea, ICU outbreaks, community vs. hospital-acquired infections). Consolidation would strengthen the narrative.

Response 4: We appreciate your review. However, the multiple time points appearing in the paragraph are mainly intended to describe the evolutionary progression and major transmission patterns of Corynebacterium striatum infection.

The “Molecular subtype” section could integrate a more structured comparison of global ST distributions.

Response 5: We appreciate your review. Due to the different typing methods used in various studies (traditional MLST, PFGE, WGS / cgMLST / clonal-complex, lineage, etc.), the definition and comparability of "ST / clone / series (lineage / clonal complex / clone)" may not be completely consistent. However, As the data of Corynebacterium striatum’ ST subtype was reported in fewer region. Based on the existing literatures, a structured comparison of ST distributions globally was differcult, We discribled the ST distributions across different main regions respectively.

The “Virulent agents” section would benefit from a clearer explanation of how each gene category mechanistically contributes to persistence or clinical outcomes.

Response 6: We appreciate your review. Table 2 exhibits the main mechanisms of toxicity and the potential corresponding gene regulation. In the this section, the main “Virulent agents” involved in multiple biological functions in C. striatum are shown.

The “Treatment” section should elaborate on practical therapeutic challenges (e.g., interpretation of C. striatum in sputum cultures, differentiating colonization vs infection).

Response 7: We appreciate your review. We add the interpretation as follows: “true infection is more likely when patients present with compatible respiratory manifestations and new pulmonary infiltrates, accompanied by repeated or predominant isolation of C. striatum, particularly in high-risk or immunocompromised individuals” The revised manuscript this change can be found page 10, and line 336.

References are abundant and up-to-date. However, minor formatting inconsistencies (punctuation, spacing, missing italics) should be corrected to align with MDPI style.

Response 8: We appreciate your review. The punctuation, spacing, missing italics have be corrected.

The conclusions are concise but could be strengthened by highlighting specific clinical or research priorities (e.g., standardized breakpoints, improved diagnostics, surveillance harmonization).

Response 9: We appreciate your review and agree with this suggestion. The conclusions highlight some specific clinical or research priorities by listing some key points.

Reviewer 3 Report

Comments and Suggestions for Authors

This review aims to summarise the epidemiology, pathogenesis, clinical characteristics and treatment strategies of C. striatum-related infection.The manuscript is well written, clear and well conceptualised. However, there are some points that need to be addressed before the manuscript is ready for publication.

The concept articulated in lines 11-14 manifests a degree of redundancy, as evidenced in lines 16-18.
The authors should highlight the most innovative aspects of the presentation of the epidemiology, pathogenesis, clinical features and treatment of Corynebacterium striatum-related infection.

……the incidence of multidrug-resistant (MDR) microorganisms in intensive care units (ICU) is high (please explain providing data) (lines 37-38)
Table 1 requires a column of references.
Please could you clarify why the conventional bacterial culture of C. striatum remains the preferred method for initial screening, given that colony morphology can be highly variable and easily confused with that of other coryneform bacteria? (lines 114-116)
Please explain the meaning, and also the difference between database coverage (line 119)
The authors should discuss why the predominant sequence types (STs) and clone groups (CGs) of C. striatum isolates varied in different regions (lines 154-155)
Table 2 and Table 3 require a column of references

Author Response

The concept articulated in lines 11-14 manifests a degree of redundancy, as evidenced in lines 16-18.

Response 1 : We appreciate your review and agree with this suggestion. We revised the content of abstract.

The authors should highlight the most innovative aspects of the presentation of the epidemiology, pathogenesis, clinical features and treatment of Corynebacterium striatum-related infection.

Response 2: We appreciate your review. In this review, based on the fundamental theories of Corynebacterium striatum-related infection, we have particularly emphasized the latest related aspects of the presentation of the epidemiology, pathogenesis, clinical features and treatment in the corresponding sections.

……the incidence of multidrug-resistant (MDR) microorganisms in intensive care units (ICU) is high (please explain providing data) (lines 37-38)

Response 3: We appreciate your review. The drug resistance rate of different bacteria in the ICU varied. So we only provide an example to illustrate. The revised manuscript this change can be found page 1, and line 48.

Table 1 requires a column of references.

Response 4: We appreciate your review. We have added corresponding references in table 1.

Please could you clarify why the conventional bacterial culture of C. striatum remains the preferred method for initial screening, given that colony morphology can be highly variable and easily confused with that of other coryneform bacteria? (lines 114-116)

Response 5: We appreciate your review. We revised the original section as follows: Conventional bacterial culture remains the preferred method for initial screening of C. striatum, as it is accessible, cost-effective, and allows recovery of viable isolates for subsequent identification and antimicrobial susceptibility testing. However, colony morphology is highly variable and may be easily confused with other coryneform bacteria. The revised manuscript this change can be found page 4, and line 119.

Please explain the meaning, and also the difference between database coverage (line 119)

Response 6: We appreciate your review. We revised the original section as follows: matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), which identifies organisms based on protein profile, has become a cornerstone for the rapid and accurate identification of C. striatum depending on mass-spectra database. The revised manuscript this change can be found page 4, and line 126.

The authors should discuss why the predominant sequence types (STs) and clone groups (CGs) of C. striatum isolates varied in different regions (lines 154-155)

Response 7: We appreciate your review. We revised the original section as follows: Due to study populations, infection control, sampling strategies, study populations, and detection methods varied, the predominant sequence types (STs) and clone groups (CGs) of C. striatum isolates vary exist differences across different regions. The revised manuscript this change can be found page 5, and line 163.

Table 2 and Table 3 require a column of references

Response 8: We appreciate your review. We have added corresponding references in Table 2 and Table 3.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript has been greatly revised and improved in quality. However, some corrections are need:

2. "History and Current Epidemiology" revised as "2. History and Current Trend". The word epidemiology should be avoided throughout.

Author Response

Thank you for pointing this out. We agree with this comment. 2. "History and Current Epidemiology" has been revised as "2. History and Current Trend". The revised manuscript this change can be found page 1, and line 57.

Reviewer 2 Report

Comments and Suggestions for Authors

The authors have revised the manuscript extensively, and the improvements in clarity, scientific organization, and coherence are clearly visible. The structure is now more logical, the transitions more natural, and most grammatical issues have been corrected. Several previously ambiguous sentences have been rewritten more precisely.

Nevertheless, a few minor issues remain:

Reference list formatting problems: The reference section still includes:
- duplicated numbering (e.g. 1. / 1.2., 13/16, stb.),
- inconsistencies caused by merging citations during revision,
- non-sequential numbering that does not match in-text citations.
- The entire reference list must be renumbered and aligned with in-text references according to MDPI style.
Minor structural smoothing: A few paragraphs still contain slight internal repetitions (e.g. recurrent descriptions of polymicrobial infections or risk factors). These do not affect scientific validity but could be trimmed for conciseness.

Figures and tables: Figure 1 (page 3) is clearer in this revision, but the label “Created by the authors” requires standard formatting per MDPI guidelines. Tables are generally improved and consistent.

Scientific accuracy: The scientific content is sound, and several sections—especially those addressing molecular mechanisms, biofilm biology, and clinical manifestations—were expanded with improved accuracy and clarity. No misleading statements were identified.

Comments on the Quality of English Language

English language polishing needed: While the revision has significantly improved the manuscript, further polishing is advisable to ensure fully professional readability. Some examples:

Occasional redundancy (e.g. repeated concepts within sentences).
Overlong or overly complex sentences that reduce readability.
Minor subject–verb agreement issues and inconsistent tense usage.
A final English proofreading pass is recommended.

Author Response

Reference list formatting problems: The reference section still includes:

duplicated numbering (e.g. 1. / 1.2., 13/16, stb.),inconsistencies caused by merging citations during revision, non-sequential numbering that does not match in-text citations.

Response 1: Thank you for pointing this out. We agree with this comment. The reference section has been reviesd one by one. We deleted the duplicated numbering.

The entire reference list must be renumbered and aligned with in-text references according to MDPI style.
Response 2: Thanks, We agree with this suggestion. The entire referenceslist have been renumbered and aligned with in-text references according to MDPI style.
- Minor structural smoothing: A few paragraphs still contain slight internal repetitions (e.g. recurrent descriptions of polymicrobial infections or risk factors). These do not affect scientific validity but could be trimmed for conciseness.

Response 3: We appreciate your review. Some paragraphs have been revised into more concise.

Figures and tables: Figure 1 (page 3) is clearer in this revision, but the label “Created by the authors” requires standard formatting per MDPI guidelines. Tables are generally improved and consistent.

Response 4: Thanks, We agree with this suggestion. “Created by the authors” has revised as follows: Created by the authors.

Scientific accuracy: The scientific content is sound, and several sections—especially those addressing molecular mechanisms, biofilm biology, and clinical manifestations—were expanded with improved accuracy and clarity. No misleading statements were identified.

Response 5: Thanks for your review.

Comments on the Quality of English Language

English language polishing needed: While the revision has significantly improved the manuscript, further polishing is advisable to ensure fully professional readability. Some examples:

Occasional redundancy (e.g. repeated concepts within sentences).
Overlong or overly complex sentences that reduce readability.
Minor subject–verb agreement issues and inconsistent tense usage.
A final English proofreading pass is recommended.

Response 6: Thank you for pointing this out. We agree with this comment. We revised the English language again.