Antimicrobial Resistance and Prevalence of β-lactamase Genes Among Multidrug-Resistant Acinetobacter baumannii Isolates from Infected Diabetic Foot Ulcers

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

General comments: Please check the English Grammarly in ms. Round all percentages to a whole number.

 

Specific comments:

I do not understand the data in Table S3.- add the profile of resistance in Table 2.

Abstract: I do not see the point of sentence „Among participants, 365 (76.0%) were male“.

Patients were form tertiary care hospital (as in abstract) or from Department of General Surgery (as in Materials and Methods)?

L135. What means „age was 56.5 (11.4) years“? Which „two groups“?

L152. „Seventy (14.58%) A. baumannii isolates were obtained.“ – explain.

Table 2: It's not clear what the number in parentheses represents, a percentage? You can rethink about the extensively-resistant and pandrug-resistant isolates.

Tables 3 and 4: what means “PCR absent“? You can merge the tables.

L210 „A. baumannii strains“ - define how many isolates; you have isolates, not strains.

At the end of discussion, you can mention that that the prevention of ulcers is crucial in palliative care. It would be nice to know does these patients were colonized with A. baumannii on the other parts of the body.  

Comments on the Quality of English Language

Please check the English Grammarly in ms. 

Author Response

Comment: Please check the English Grammarly in ms. Round all percentages to a whole number.

Response: The manuscript has been thoroughly revised for English grammar and clarity.

 

Specific comments:

Comment: I do not understand the data in Table S3. Add the profile of resistance in Table 2.

Response: Thank you for your valuable suggestion. In response, we have removed Table S3 to avoid confusion and improve clarity. The key antimicrobial susceptibility data previously presented in Table S3 have now been incorporated into a revised Table 2

 

Comment: Abstract: I do not see the point of the sentence “Among participants, 365 (76.0%) were male.”

Response: Thank you for the suggestion. We have removed the sentence from the abstract to maintain focus and relevance.

 

Comment: Patients were from tertiary care hospital (as in abstract) or from Department of General Surgery (as in Materials and Methods)?

Response: Thank you for your suggestion. Due to the word limit in the abstract, we have opted to omit the specific details about the Department of General Surgery at Yenepoya University Hospital and its status as a tertiary care center. However, this information is clearly stated in the Materials and Methods section for further clarification.

 

Comment: L135. What does “age was 56.5 (11.4) years” mean? Which “two groups”?

Response: Thank you for your comment. To improve clarity, we have revised the sentence as follows:
“A total of 480 participants were included in this study; 365 (76%) were male, and the mean (SD) age of all participants was 56.5 (11.4) years.

 

Comment: L152. “Seventy (14.58%) A. baumannii isolates were obtained.” – explain.

Response: Thank you for your comment. We have revised the sentence for clarity.

 

Comment: Table 2: It's not clear what the number in parentheses represents, a percentage? You can rethink about the extensively-resistant and pandrug-resistant isolates.

Response: Thank you for your comment. We have revised the table to clarify that the numbers in parentheses represent the percentages of isolates. The table has been updated for better clarity and to ensure it accurately reflects the antimicrobial resistance profiles of A. baumannii isolates obtained from DFIs.

 

Comment: Tables 3 and 4: What does “PCR absent” mean? You can merge the tables.

Response: We appreciate the reviewer’s suggestion. To avoid confusion, we have removed the phrase “PCR absent” and clarified that the respective genes were not detected. Additionally, as recommended, Tables 3 and 4 have been merged into a single table (now Table 3) to improve clarity and readability.

 

Comment: L210 “A. baumannii strains” – define how many isolates; you have isolates, not strains.

Response: Thank you for pointing out this inaccuracy. The term “strains” has been replaced with “isolates,” and we have clearly stated the number of A. baumannii isolates used in this part of the analysis.

 

Comment: At the end of discussion, you can mention that the prevention of ulcers is crucial in palliative care. It would be nice to know whether these patients were colonized with A. baumannii on other parts of the body.

Response: We appreciate the reviewer’s suggestion. As advised, we have added a discussion point at the end of the manuscript highlighting the importance of DFI prevention in palliative care settings. We have also acknowledged the limitation regarding the assessment of A. baumannii colonization at other body sites.

 

Comments on the Quality of English Language:

Response: The manuscript has been professionally edited to improve grammar, clarity, and readability.

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors, I had the pleasure of reading your manuscript entitled "Antimicrobial Resistance and Prevalence of β-lactamase Genes Among Multidrug-Resistant Acinetobacter baumannii Isolates from Infected Diabetic Foot Ulcers.”  After reading your manuscript, I have made some observations.

Line 73: You included all patients in a time period (480); therefore, the inclusion criteria were incorrect. Please correct.

Table S2, The total number of isolates was 665; therefore, some patients had more than one type of microorganism or some of the same microorganism was isolated in both pus and exudates as well as tissue.

Table S3, column ≥4 must be 0 (0%) please verify.

Why did some clinical isolates, non-ESBL producers and Non- MBL producers, have ESBL and MBL genes? Please discuss these inconsistencies in the discussion section.

I hope that my comments will help improve the quality of the manuscript.

Author Response

 

Dear authors, I had the pleasure of reading your manuscript entitled "Antimicrobial Resistance and Prevalence of β-lactamase Genes Among Multidrug-Resistant Acinetobacter baumannii Isolates from Infected Diabetic Foot Ulcers.”  After reading your manuscript, I have made some observations.

Line 73: You included all patients in a time period (480); therefore, the inclusion criteria were incorrect. Please correct.

Response: Thank you for your observation. We agree and have revised the text to clarify that the study included all patients with diabetic foot infections presenting during the defined study period. The inclusion was based on the temporal cohort of DFI cases, not specific stratified inclusion criteria. The revised sentence now reads:

“This study included all patients diagnosed with diabetic foot infections (DFIs) who presented to the tertiary care hospital during the study period.”

 

 

 

Table S2, The total number of isolates was 665; therefore, some patients had more than one type of microorganism or some of the same microorganism was isolated in both pus and exudates as well as tissue.

Response: Thank you for the observation. We have clarified in the footnote of Table S2 that although only one sample per patient was included for culture and sensitivity testing, multiple microbial isolates could be identified from a single sample. Additionally, the same microorganism could be isolated from both pus/exudates and tissue, contributing to the total count of 665 isolates. This has been explicitly stated in the revised table footnote for clarity.

 

Table S3, column ≥4 must be 0 (0%) please verify.

Response: Thank you for the comment. As per the suggestion of another reviewer and for better clarity and focus of the manuscript, Table S3 has been removed from the revised version.

 

Why did some clinical isolates, non-ESBL producers and Non- MBL producers, have ESBL and MBL genes? Please discuss these inconsistencies in the discussion section.

 

Response: Thank you for pointing out the inconsistencies regarding the presence of ESBL and MBL genes in some clinical isolates. We have discussed these findings in detail in the revised discussion section to provide clarity.

 

I hope that my comments will help improve the quality of the manuscript.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The previous comments are addressed and ms looks good now.

However, English can be improved before publication, e.g.:

DFIs who presented to the tertiary care

isolated and characterized 70 A. baumannii isolates.