Machine Learning Models to Establish the Risk of Being a Carrier of Multidrug-Resistant Bacteria upon Admission to the ICU

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

 

• Line 19: “living in nursing home” → should be “living in a nursing home”.

• Line 33: “within hos- pitals” → typo, should be “within hospitals” (remove hyphen).

• Line 180: “most influential factors for MDR presence” → consider rephrasing to “most influential factors associated with MDR presence”.

• Line 215: “ROC and ABC curves” → likely a typo; should be “ROC and AUC curves”.

• Line 286: “meticilin resistant Staphylococcus aureus” → should be “methicillin-resistant Staphylococcus aureus”.

The discussion would benefit from a stronger emphasis on the clinical relevance of early detection of MDR carriage risk. This point could be reinforced by citing recent studies that highlight both the clinical and epidemiological impact of timely identification at ICU admission. Please add appropriate references in the Discussion section

Bavaro DF, De Gennaro N, Belati A, Diella L, Papagni R, Frallonardo L, Camporeale M, Guido G, Pellegrino C, Marrone M, Dell'Erba A, Gesualdo L, Brienza N, Grasso S, Columbo G, Moschetta A, Carpagnano GE, Daleno A, Minicucci AM, Migliore G, Saracino A. Impact of a Pro-Active Infectious Disease Consultation on the Management of a Multidrug-Resistant Organisms Outbreak in a COVID-19 Hospital: A Three-Months Quasi-Experimental Study. Antibiotics (Basel). 2023 Apr 6;12(4):712. doi: 10.3390/antibiotics12040712. PMID: 37107073; PMCID: PMC10135160.

Author Response

Comments 1:

• Line 19: “living in nursing home” → should be “living in a nursing home”.
• Line 33: “within hos- pitals” → typo, should be “within hospitals” (remove hyphen).
• Line 180: “most influential factors for MDR presence” → consider rephrasing to “most influential factors associated with MDR presence”.
• Line 215: “ROC and ABC curves” → likely a typo; should be “ROC and AUC curves”.
• Line 286: “meticilin resistant Staphylococcus aureus” → should be “methicillin-resistant Staphylococcus aureus”.

The discussion would benefit from a stronger emphasis on the clinical relevance of early detection of MDR carriage risk. This point could be reinforced by citing recent studies that highlight both the clinical and epidemiological impact of timely identification at ICU admission. Please add appropriate references in the Discussion section

Bavaro DF, De Gennaro N, Belati A, Diella L, Papagni R, Frallonardo L, Camporeale M, Guido G, Pellegrino C, Marrone M, Dell'Erba A, Gesualdo L, Brienza N, Grasso S, Columbo G, Moschetta A, Carpagnano GE, Daleno A, Minicucci AM, Migliore G, Saracino A. Impact of a Pro-Active Infectious Disease Consultation on the Management of a Multidrug-Resistant Organisms Outbreak in a COVID-19 Hospital: A Three-Months Quasi-Experimental Study. Antibiotics (Basel). 2023 Apr 6;12(4):712. doi: 10.3390/antibiotics12040712. PMID: 37107073; PMCID: PMC10135160.

Response 1:

Thank you very much for dedicating your time to reviewing our manuscript. Below, we provide detailed responses to your comments, and the corresponding revisions have been incorporated in the re-submitted files. Please see the attachment.

• All lines were corrected, except for the hyphen in “hospital”, which appears this way due to the journal’s configuration.
• Thank you for your contribution. The discussion on clinical relevance of early detection of MDR carriage risk has been included in the first paragraph of the discussion (lines 229-236), and the relevant bibliography has been added.

Reviewer 2 Report

Comments and Suggestions for Authors

1. In similar papers the value of the RZ criteria were calculated (Abella Álvarez et al. 2021; Carvalho-Brugger et al. 2023). Authors should carefully describe the novelty of their work.
2. Authors add inclusion/exclusion criteria, but handling missing data is not described.
3. The timeline is 2014-2016, but it will be more interesting MDR risks especially after-COVID changes in ICU epidemiology.
4. Figure 2 is very simple clarify cut-off scores and how they can be applied in the ICU workflows.
5.  It will be better to summarize the key findings  in the main text, not only in the appendix.
6. How medical doctors should balance the sensitivity  vs specificity?
7. The reference style is not correct modify it according to the journal guidilines.

Author Response

Comments 2:

1. In similar papers the value of the RZ criteria were calculated (Abella Álvarez et al. 2021; Carvalho-Brugger et al. 2023). Authors should carefully describe the novelty of their work.
2. Authors add inclusion/exclusion criteria, but handling missing data is not described.
3. The timeline is 2014-2016, but it will be more interesting MDR risks especially after-COVID changes in ICU epidemiology.
4. Figure 2 is very simple clarify cut-off scores and how they can be applied in the ICU workflows.
5.  It will be better to summarize the key findings  in the main text, not only in the appendix.
6. How medical doctors should balance the sensitivity  vs specificity?
7. The reference style is not correct modify it according to the journal guidilines.

Response 2:

Thank you very much for dedicating your time to reviewing our manuscript. Below, we provide detailed responses to your comments, and the corresponding revisions have been incorporated in the re-submitted files. Please see the attachment.

• The authors have reinforced the implications of the novelty of this article compared to previous publications. See line 285.
• Patients excluded due to missing data have not been analyzed in the study, precisely because of the lack of any microbiological studies that could contribute information to our study. We consider it important to report that of all admissions to our ICU during the study period, only a small number of patients did not undergo any tests.
• We completely agree that it would be very interesting to have data from the post-COVID period, but that would be data for another study, which is not yet available/analyzed.
• Figure 2: We have changed the order of appearance in the text of Table 4 and Figure 2 to make the information provided easier to understand. We have also added information to the text (discussion, line 288) that we believe improves the applicability of the simple score in the ICU.
• We have restructured some sentences in the discussion and added data to improve understanding of the results.
• In the final lines of “discussion”, we add that the decision to perform more or fewer isolations, balancing the sensitivity and specificity of these criteria and tools, should be made in each unit, depending on the prevalence of MRB, with stricter criteria in settings with high colonization rates.
• Thank you for your comment. We have revised the references in accordance with the journal's guidelines.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Thanks for your response. But in the attached file any changed was not observed. Moreover, I know it is technical mistake but please carefully review references and correct reference style. Some references were written with Capital letter, avoid it and follow the rules. And highlight your changes in the revised version.