Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

1. In introduction please explicitly explain the current gap with already existing literature, correlating ESBL status with drainage choice, antibiotic duration, and early clinical response in acute obstructive pyelonephritis.
2. The aim of study must be direct, revise the sentence
3. The manuscript does not specify the antimicrobial susceptibility testing standards (EUCAST or CLSI) used for interpretation of resistance. The authors should clarify the testing methodology, breakpoint system, and ESBL confirmation procedure to ensure reproducibility.
4. Line 207-209, “However, no association was observed between patients' gender and residence (p < 0.05, OR < 1, Chi-square; Table 1). Authors stated "no association" but p<0.05.  Line 221-223, Conversely, OR > 1 suggests that hypertension, CKD, and recurrent lithiasis were associated with the gender of patients with AOP (p > 0.05, Table 1).
   The interpretation of statistic could confuse the readers. Please recheck again.
5. Line 186, 261, 461, naming 'gram' for bacteria, must be capitalized "Gram".
6. Please check the consistency of the manuscript unit

Author Response

Thank you so much for your time, attention, and constructive comments, which have helped improve the quality of our manuscript. Please find our responses in the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This retrospective study is an excellent paper on acute obstructive pyelonephritis; however, There are here some minor suggestions to improve it:

1. Tabs 2, 3, 4 and 6 should be on the same page to improve the reading of the columns
2. As a clinician, I would like some explanation in the methods about the use of “Spearman correlation analysis” with attention at the two matrices presented in Figure 4 which are rather obscure for most of us.
3. LMR (lymphocyte-to-Monocyte Ratio) ratio is rarely used in clinical medicine even if is well known that an absolute low lymphocyte count is a poor prognostic indicator in infections and malignancies. In this study it is stated that a significant negative correlation with clinical improvement: this statement is less clear than simply saying that a low lymphocyte count is associated with a poor prognosis
4. Legend of Table 2 should include the explanation for parameters 0 and 1 which mean absent and present of each row (Symptoms, Lumbar pain, and so on).
5. In Table 2 you describe 32 cases of pyonephrosis without differentiating between focal bacterial nephritis and frank renal abscess while in paragraph 1.3 is claimed that distinction between these two nosological entities.
6. In Table 4 it is shown an association between Escherichia coli and treatment wit Ciprofloxacin and Meropenem while Klebsiella spp is associated with Ceftriaxone and Pip/tazo: is there a correlation with the resistance patterns of Escherichia and Klebsiella shown in Table 3?
7. In Table 5, it is stated that 56 nephrostomies were done without saying how many were the percutaneous drainage of frank renal abscesses.
8. In Table 6, the mean length of antibiotic therapy is between 9 and 11 days while most guideline suggest shorter treatments for quinolones (5-7 days) compared with beta-lactams (10 days) and cotrimoxazole (14 days)

Author Response

Thank you so much for your time, attention, and constructive comments, which have helped improve the quality of our manuscript. Please find our responses in the attachment. 

Author Response File: Author Response.pdf