Molecular Identification, Virulence Factors, and Antifungal Susceptibility Profiles of Candida Isolates from Clinical Samples of Intensive Care Patients
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsOverall, the manuscript is interesting, addressing a growing global problem. The work is comprehensive because it examines the susceptibility, virulence factors, and prevalence of Candida species in patients with severe or intensive care infections. However, this version of the manuscript requires several improvements for better quality and presentation. The main weaknesses and improvements the authors should make are detailed below:
Introduction: Generally, it is good or sufficiently complete.
Results: The description and wording of the results is the article's main weakness. Although the authors performed several tests to identify the species, their virulence factors, and susceptibility, the current version of these results is unclear. In many cases, it is too brief or concise, lacking a clear description of the findings. In other cases, it is redundant, repeating the same phrases more than once. Lines 76 to 78 are redundant in how the result is written; it should be rewritten indicating only the percentage or the number.
The caption for Figure 1 is poor; it should also state that the identification shown in that figure is based on molecular identification with the ITS.
While Figure 2 is illustrative, it presents nothing new, making it unnecessary in the article. Furthermore, the caption does not indicate the growth conditions or time of the colonies according to the images under each letter. Are they all grown after 48 hours? Or are they grown for 5 days? It's unclear; this needs improvement. Line 97 is meaningless; it only mentions the phylogenetic tree. It doesn't introduce anything new, such as how it was created, what parameters and phylogenetic method were used, there are no new species, no comparisons were made with type strains, and there are no strains from international collections included in the tree. In general, Figure 3 is unnecessary because simply presenting the BLAST results with the ITS in a table or paragraph is sufficient. It should be removed, or perhaps included as supplementary material.
Figure 4 is also not very useful; the microscopic images are not described in the results, and they don't contribute much. This information is already widely known in the literature and offers nothing new. It should also be removed. Table 2 in the "Hyphae/Pseudohyphae" section is confusing and contradictory to what is known about several species of the genus Candida. It is widely known that the albicans species is the one that produces pseudohyphae, and the results indicate that only a certain percentage produce them. They also mention that other species, where this is not usually a characteristic, produce them, creating confusion. The authors should carefully review this table and verify their claims.
Table 3 is unclear; it lacks an explanatory paragraph and is inherently confusing to interpret and review.
On line 109, the authors mention Figure 6 before Figure 5, which is illogical. The presentation of the results should be restructured to follow a logical order.
Discussion: Lines 215 to 217 contain a repetitive paragraph that already states what has been written previously. Please avoid such repetition in the article's writing. In general, the discussion mentions many works, but it lacks a coherent structure. Citing so many works simply for the sake of citing them is not recommended; instead, the discussion should be written in a way that is easy to follow. It needs to connect all the points made. In short, the writing and organization of the discussion narrative need improvement.
Minor comments: The genus name *Candida* appears in many parts of the text without italics. Please correct it to italics.
Finally, the authors should include more interesting figures such as those of proteases, hemolysins, especially the double one, and give more emphasis to the MIC results. It also raises the question of why they tested few antifungals; there are no echinocandins and more azoles. This should be considered in future susceptibility studies.
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for Authors The manuscript by Çelik et al., investigates species identification accuracy, virulence factor distribution, and antifungal susceptibility among Candida isolates from ICU patients. I have some concerns about the manuscript as follows: Turkey1. The study is limited to a single center in Turkey. Please clarify whether patient demographics and clinical conditions are representative of broader ICU populations.
2. While 100 isolates provide a reasonable dataset, rare species (e.g., C. krusei, C. rugosa, C. fabianii) were excluded from statistical analysis. Consider discussing how this exclusion affects interpretation of species diversity and resistance trends.
3. The manuscript reports MALDI-TOF MS as highly accurate. However, please provide confidence intervals or kappa statistics for agreement between methods.
4. Discuss the cost and feasibility of MALDI-TOF MS implementation in resource-limited settings compared to chromogenic media.
5. The criteria for positive protease and phospholipase activity (PRzo and PFzo ratios) should be clearly defined in the Methods section. Were these thresholds validated against reference strains?
6. The study does not link virulence factor presence to patient outcomes. Consider acknowledging this as a limitation and suggesting future research directions.
7. The exclusion of echinocandins (first-line therapy for candidemia) is a notable gap. Please justify this choice or acknowledge it as a limitation.
8. Although Kruskal–Wallis tests showed no significant interspecies differences, species-specific MIC trends were observed. Consider discussing their clinical relevance.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsBased on the changes made by the authors, I agree with the improvements and the manuscript is ready for publication.
Reviewer 2 Report
Comments and Suggestions for AuthorsThe authors have addressed my concerns
