Review Reports

Round 1

Reviewer 1 Report

General comment:

The work titled “Antibiotics used for covid-19 in-patients from an infectious disease ward” presents data relating to patients hospitalized with COVID-19 and antimicrobial therapy, highlights an excessive use of antibiotic treatment, and proposes factors correlated with the unjustified antibiotic usage.

Overall, the work is technically sound, well-written and contextualized with the current literature.

I suggest some minor revisions that would further improve this work.

 

Abstract:

Line 25. “covid-19” should be COVID-19.

 

Introduction:

Line 65. “it is essential that prescribing doctors to differentiate between patients at risk” I would suggest changing “that” to for.

 

Materials and Methods:

Lines 102-109. Was correction used for multiple testing? Please specify the correction method.

 

Results:

Lines 141-148. Bacterial names should be italicized.

Line 162. “[(absolute value x 109/L)” I suspect it should be 10⁹.

Author Response

We thank the reviewer for the thorough analysis of the submitted manuscript and for the suggestions that were made. Thereby, we integrated the comments and we revised the manuscript taking into consideration the reviewer’s recommendations.

 

Point 1:

Abstract:

Line 25. “covid-19” should be COVID-19.

Response 1: We have made the modification.

 

Point 2:

Introduction:

Line 65. “it is essential that prescribing doctors to differentiate between patients at risk” I would suggest changing “that” to for.

Response 2: We agreed with the comment, therefore we modified accordingly.

 

Point 3:

Materials and Methods:

Lines 102-109. Was correction used for multiple testing? Please specify the correction method.

Response 3: We did not use multiple testing.

 

Point 4:

Results:

Lines 141-148. Bacterial names should be italicized.

Line 162. “[(absolute value x 109/L)” I suspect it should be 10⁹.

Response 4: We have revised and modified accordingly.

Reviewer 2 Report

Dear Authors,

I congratulate all the Authors for their contributions to the writing of the manuscript entitled “Antibiotics used for covid-19 in-patients from an infectious disease ward” submitted to the Antibiotics journal. Ideally, it is important to determine the factors that correlated the unnecessary use of antibiotics for COVID-19 patients. In general, this is an interesting study. However, the manuscript presents preliminary study lacking novelty for publication in the journal and is poorly written. A deep investigation in the topic should be presented to provide complete results, gaps, perspective, and future direction in the field. Other specific comments I addressed below:

1.  Abstract – the aim and methods of the study were not properly described. Please describe how did you analyse factors that justify antibiotic treatment?

2.    Line 25 – COVID-19 should be written in capital. COVID-19 in the title should be in capital too.

3.    Lines 19, 20 and 21 – use a period/point (not a comma) to indicate decimal place. Please check the manuscript thoroughly for this correction, i.e. line 34, 40, etc.

4.  Line 43 – please list the atypical bacteria that are most frequently associated with COVID-19 coinfection.

5.  Specific objectives of the study were not written properly, lacking clear aims.

6.  Methods on patient recruitment and data collection were redundant and difficult to follow. The Authors should concisely and precisely explain the protocols used in the study so that the results could easily be reproduced.

7.   Please review the entire manuscript and all bacterial species name should be in italics (i.e. in lines 141-148). Also, n should be written in italics. Bacterial names should be written in short form when they are mentioned again later (i.e. lines 224-226).

8.    It is unusual to separate tables and figures (section 3.3) from the main text of the result section. I suggest the Authors to include the figures and tables, and cite them immediately before they are first mentioned in the main text.

9.  Please review the use of spacing, punctuation marks and grammar throughout the manuscript.

10. It is not a good way to introduce a topic by leading with authors' names. i.e. Ng TM et al. in line 204, Langford BJ et al. in line 207, and many other places throughout the manuscript. Concentrate on the point made and then cite the authors at the end of the sentence. Who they are is less important.

11. Please confirm that the study received no external funding and if available, please mention the funding details in line 286.

 

I consider the article is insufficiently comprehensive, and it needs a proper organization/structuring/reporting to make it more interesting. For these reasons, I do not suggest the acceptance of this manuscript at Antibiotics for now until these issues have been properly addressed. My best wishes to all Authors.

Author Response

We thank the reviewer for the thorough analysis of the submitted manuscript and for the suggestions that were made. Thereby, we integrated the comments and we revised the manuscript taking into consideration the reviewer’s recommendations.

 

Point 1:

Abstract – the aim and methods of the study were not properly described. Please describe how did you analyse factors that justify antibiotic treatment?

Response 1: In order to estimate the excess of antibiotic prescriptions, we recorded all documented bacterial infections (positive microbiology result, increased white blood cell count, increased procalcitonin level, bacterial pneumonia aspect on CT scan or X-ray, clinical features suggestive of bacterial infection) and then we grouped the patients in four categories:

• those who received antibiotics which had suspected or confirmed bacterial co-infection
• those who received antibiotics even if they shouldn’t have
• those who didn’t receive antibiotics even if they should have received
• those who weren’t prescribed antibiotics and shouldn’t have received.

 

Point 2:

Line 25 – COVID-19 should be written in capital. COVID-19 in the title should be in capital too.

Response 2: We have made the modification.

 

Point 3:

Lines 19, 20 and 21 – use a period/point (not a comma) to indicate decimal place. Please check the manuscript thoroughly for this correction, i.e. line 34, 40, etc.

Response 3: We have revised the manuscript and modified accordingly.

 

Point 4:

Line 43 – please list the atypical bacteria that are most frequently associated with COVID-19 coinfection.

Response 4: We have made the modification.

 

Point 5:

Specific objectives of the study were not written properly, lacking clear aims.

Response 5: The objective of our study was to estimate the excess of antibiotic prescriptions for patients with COVID-19 and to identify the factors that were correlated with the unjustified antibiotic usage (for example: older age, higher Charlson index, severe/critical COVID-19 disease, immunomodulating treatment).

 

Point 6:

Methods on patient recruitment and data collection were redundant and difficult to follow. The Authors should concisely and precisely explain the protocols used in the study so that the results could easily be reproduced.

 

Response 6: We enrolled all patients diagnosed with COVID-19 who were consecutively hospitalized on an infectious disease clinical ward from our institute, from November 2021 to January 2022, after signing the informed consent.  We excluded the patients requiring intensive care and those with end-stage renal disease.

 

Point 7:

Please review the entire manuscript and all bacterial species name should be in italics(i.e. in lines 141-148). Also, n should be written in italics. Bacterial names should be written in short form when they are mentioned again later (i.e. lines 224-226).

Response 7:  All bacterial species name were written in italics. There has got to be a problem with the Word version. As for the second comment, we have modified accordingly.

 

Point 8:

It is unusual to separate tables and figures (section 3.3) from the main text of the result section. I suggest the Authors to include the figures and tables, and cite them immediately before they are first mentioned in the main text.

Response 8:  We have implemented the suggested changes.

 

Point 9:

Please review the use of spacing, punctuation marks and grammar throughout the manuscript.

Response 9: We have revised and modified accordingly.

 

Point 10:

It is not a good way to introduce a topic by leading with authors' names. i.e. Ng TM et al. in line 204, Langford BJ et al. in line 207, and many other places throughout the manuscript. Concentrate on the point made and then cite the authors at the end of the sentence. Who they are is less important.

Response 10: We have implemented the suggested changes.

 

Point 11:

Please confirm that the study received no external funding and if available, please mention the funding details in line 286.

Response 10: We have already mentioned that there was no external funding (line 292).

 

Considering the lack of data regarding the antibiotics’ prescription in COVID-19 in Romania, we consider that the study is very important to antimicrobial stewardship.

Round 2

Reviewer 2 Report

Again, I congratulate all the Authors for their contributions to the writing of the manuscript.

I believe that the manuscript is now suitable for publication in the Antibiotics journal and can be accepted after minor spell checking/editing.