Superinfections in Hospitalized COVID-19 Patients (Super COVID-19): Data from the Multicentric Retrospective CH-SUR Cohort Study in Switzerland

Round 1

Reviewer 1 Report

Actually, I can see that the paper is good, but some comments appear to be minor :

1- The number of references is too large. I suggest removing the old one 

2- Some paragraphs are too large and some are small; it should be unified 

3- The style of the references is not the same 

4-Why is there no analysis section or result section, or graphs? 

5- Some values in Table 1 have a P value less than 0.01, which is not significant

6- The paper needs some English improvements, many grammatical mistakes, see the discussion as an example, and the last paragraph 

 

7- Make a paragraph in the introduction to demonstrate the main contribution of the paper, what is new in the paper, and the difference between your work and previous ones. Clearly articulate the novelty and significance of their contribution to the field 

8- If possible, make Table 1 on one page.

9-  Authors must discuss how the study can be extended as a future course of study.?

10- Figure 2. Forest plot showing the multivariable, adjusted associations between selected variables 265
and coinfections

This figure's X-axis Scale is negative, why?

Any explanation?

11- The discussion section is too large, I suggest removing the unneeded paragraph 

12- Table 3. Time-dependent distribution of the ten most commonly isolated pathogens in respiratory 252
COIs

The size is 343. Why did the authors use this sample? What will be the effect of increasing or reducing it?

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

The authors examined risk factors and prognosis for COVID-19 patients with comorbidities unrelated to SARS-CoV-2, utilizing data from several institutions in Switzerland. This study indicates that co-infections in COVID-19 patients may correlate with deteriorated outcomes. This study may yield significant insights for the management of COVID-19. The reviewer offers the following remarks.

Major comments

1. The patient's background information in the "convenience sample" is absent. Should the authors disclose this information?
2. The authors attribute the rise in the percentage of confirmed COI throughout the three waves to the heightened utilization of immunosuppressive medications. However, while the study provides information on how the use of tocilizumab has changed, it does not look into whether changes in the use of other immunosuppressive medications are related. Please incorporate a discussion that encompasses pertinent information.
3. Examine the factors contributing to the rising prevalence of ESBL-producing E. coli over time.
4. Given the increase in ESBL-producing bacteria, should tazobactam-piperacillin or carbapenems be chosen instead of cefepime for treating delayed respiratory COI with prescribed antibiotics?
5. Concerning the appropriate use of antibiotics, does the data from this study indicate that antibiotic therapy improves prognosis in instances with suspected COI?

 

Minor comments

1. Concerning methods of imputing missing values, multiple imputation or single imputation may be suitable.
2. Does the "suspected COI" category in Table 1 encompass patients designated as "proven"? Does the phrase "superinfections" in Table 1 have a specific meaning?
3. Please italicize the microbiological nomenclature.
4. Table S3 contains parts where the percentages surpass 100; please revise these discrepancies.
5. Based on Table S3, should Staphylococcus aureus exhibiting resistance be classified as MRSA?
6. If "Other" appears in Table 3, a footnote must indicate the specific details.
7. What defines a high CURB-65 score threshold?

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

I accept the revised version 

I accept the revised version 

Author Response

We would like to thank once again the reviewer for the valuable feedback in the first round.

Reviewer 2 Report

The authors have genuinely addressed the reviewer's comments, and their replies are earnest. Consequently, I wish to endorse the publishing of their manuscript. Nonetheless, a few small corrections persist, and no response is required for these. In reply to comment 4 from the reviewer, I would like to add that the authors' perspectives on the prevalence of ESBL-producing bacteria in Switzerland are justifiable.

Minor comments

The symbol representing the percentage of "Third wave" in the BSI column in Table S2 is duplicated; please rectify this error.

Standardize the phrase 'superinfection' to 'coinfection' in the title and footnote of Figure S3.

Author Response

We would like to once again thank the reviewer for the constructive comments in the first round and for noticing the typos in the second round.