Submited on: 20 Sep 2010 07:33:52 AM GMT
Published on: 20 Sep 2010 04:35:07 PM GMT
 

1 Is the subject of the article within the scope of the subject category? Yes
2 Are the interpretations / conclusions sound and justified by the data? No
3 Is this a new and original contribution? No
4 Does this paper exemplify an awareness of other research on the topic? No
5 Are structure and length satisfactory? Yes
6 Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience? No
7 Can you suggest any reductions in the paper, or deletions of parts? No
8 Is the quality of the diction satisfactory? No
9 Are the illustrations and tables necessary and acceptable? Yes
10 Are the references adequate and are they all necessary? Yes
11 Are the keywords and abstract or summary informative? Yes
  • Other Comments:

    Identification protocol not satisfactory. Authors should add suggar assimilation test and chromogenic medium if PCR is not available to confirm listed organism. There was no mention of what strain of E coli was identified and so we can not say it was pathogenic or not. Disc difusion not enough. Authors shout add MIC results at least with E-test. Disc content of atimicrobial agents should be included. How sample was collected to eliminate contamination was not included and we have no idea how this experiment was controlled. Conclussion on prescription is out of scope with the original intention of this study. Authors should only conclude on what the study achieved.

  • Competing interests:
    NIL
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    Yes
  • References:
    Available online (OJHAS) Agwu E, Ihongbe JC, Okogun GRA, Ezeonwumelu JOC, Igbinovia O. Chromobacterium violacium associated with recurrent vaginal discharge among apparently healthy females in Ekpoma Nigeria. OJHAS, 2007, 1: 2. Local Nigerian journal: (Not available online) Agwu, E., Agba, M.I., Nwobu, G.O., Isibor, J.O., Okpala, H.I., Ohihion, A.A., and Uzoaru, S.C. Pattern of UTI Among Female Students of National Veterinary Research Institute Vom. J Biomed Sc in Africa 2004, .2, (2):15-17.
  • Experience and credentials in the specific area of science:

    see profile

     

  • How to cite:  AGWU E .Dean of Faculty and Senior Lecturer of Medical Microbiology and Parasitology[Review of the article 'Community-Acquired Urinary Tract Infections in a Rural Area: Predominant Uropathogens, and their Antimicrobial Resistance ' by Batchoun R].WebmedCentral 2011;2(12):WMCRW001305
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Review of
Posted by Dr. Biswaroop Chatterjee on 09 Jan 2011 01:45:09 AM GMT

1 Is the subject of the article within the scope of the subject category? Yes
2 Are the interpretations / conclusions sound and justified by the data? Yes
3 Is this a new and original contribution? Yes
4 Does this paper exemplify an awareness of other research on the topic? Yes
5 Are structure and length satisfactory? Yes
6 Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience? Yes
7 Can you suggest any reductions in the paper, or deletions of parts? Yes
8 Is the quality of the diction satisfactory? Yes
9 Are the illustrations and tables necessary and acceptable? Yes
10 Are the references adequate and are they all necessary? Yes
11 Are the keywords and abstract or summary informative? Yes
  • Other Comments:

    Dear Professor Nimri,

     

    Congratulations on publishing this timely article on one of the most widespread community-acquired infections worldwide. I am especially pleased to see that you work covers a rural area since these are under-represented in most studies because of the relative lack of laboratory facilities in such places. Having worked in a similar situation myself, I can appreciate how much effort you must have put in to run a functional microbiology set-up in a small place far away from Amman.

     

    Please find some comments on your article in the following paragraphs. These comments are not meant to be critical of your work. Instead, they have been included with the hope that you might find them useful to improve the content and presentation of your article, which is otherwise very good.

     

    First paragraph of Abstract: “The approach to these infections remains a difficult and sometimes controversial issue, especially in asymptomatic and symptomatic bacteriuria.”. Perhaps you meant “especially in asymptomatic bacteruria” because there is no confusion about what to do in symptomatic bacteruria. We treat it, as simple as that.

     

    Third paragraph of Abstract: Please do not present the findings on Candida spp. and E. coli in the same sentence because most E. coli isolations were from uncomplicated UTI while most Candida isolations were from patients with anatomical anomalies or diabetes or a history of antibiotic therapy. Putting them together in the same sentence gives the impression that they were from patients in the same risk group.

    Having said that, the isolation of Candida spp. in nearly 15% of positive cultures remains a significant and interesting finding.  Other researchers should try to see if a similar situation exists in rural areas in other countries in West Asia. One could also look for possible explanations.

     

    Second paragraph of Introduction: Diagnosing UTI on the basis of bacteriuria of 105 colony forming units (CFUs) per milliliter of a single organism has been the traditional approach but it reduces sensitivity at the cost of specificity. For many years, the consensus definition adopted by the Infectious Diseases Society of America has been 103 colony-forming units CFU /mL or more of a uropathogen for cystitis (sensitivity 80% and specificity 90%) and 104 CFU / mL or more for pyelonephritis (sensitivity 90% and specificity 95%).

                (Reference:  Rubin RH, Shapiro ED, Andriole VT, et al.

                  Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Infectious Diseases Society of America and the Food and Drug Administration.

                 Clin Infect Dis 1992;15(Suppl 1):S216–227.)

     

    Third paragraph of Introduction: Age has been described twice as a risk factor for recurrent UTI: first in the second sentence and then in the third sentence. Once is good enough.

     

    Seventh paragraph of Introduction: “The objectives of this study were to determine the incidence of UTI”.  To determine incidence, it is necessary to define the catchment population. Assuming that all people of the Badia area seek healthcare from governmental health centres, and that all patients with UTI were worked up, then the incidence would be 250 in the Badia area in two years and the incidence rate per thousand population, per year, can be worked out from that.

     

    Methods: Since the article is on community-acquired UTIs, it would be good to mention what criteria you used to decide whether an infection was community-acquired or not.

     

    Second paragraph of Methods: “Specimens were examined macroscopically for cloudy appearance or blood strained.” The correct word should be ‘staining’ and not ‘strained’.

     

    Second paragraph of Methods: “A drop of urine was examined microscopically for the presence and number of white blood cells, and counts of 10 cells/ milliliter urine was considered significant.”  Did you mean 10 cells per high-power (400x) field instead of milliliter? An absolute white cell count of 10 cells per milliliter of urine is within normal limits. Please specify the speed at which the urine was centrifuged and the duration of centrifugation.

     

    First paragraph of Results: “The lowest incidence of infection (10%) was seen among the age group 13-20 year old, and 12 years old patients (20%).“  The meaning of this sentence is not clear. Did you mean to say that 20% of patients were in the 12 – 20 year age group?

     

    Last paragraph of Results:  There is no doubt that previous antibiotic therapy is statistically linked to UTI but can we call it a risk factor? Because multiple episodes (relapse or recurrence) of UTI are so common, isn’t it equally likely that a history of antibiotic therapy is just a surrogate marker for past UTI?

     

    Second and third paragraphs of Discussion: These are two parts of the same paragraph and should be merged.

     

    Fifth paragraph of Discussion: “While some urinary isolates of NTS may be fecal contaminants,….”  A urine sample with faecal contamination will usually show multiple bacterial morphotypes on microscopy and invariably yield multiple species on culture. Isolation of a single non-typhoidal Salmonella spp. on urine culture can be safely considered to be significant.

    Please avoid ‘Minn’ and give the full form, i.e. Mayo Clinic, Minnesota, U.S.A.

     

    Sixth, seventh, eighth and ninth paragraphs of Discussion: The isolation of Serratia marcescens, Stenotrophomonas maltophilia and Plesiomonas shigelloides in pure culture with significant colony counts from even a small number of patients with community-acquired UTI is unexpected, and therefore, highly interesting.  Attempts should be made to find out if a similar situation prevails in rural areas of other West Asian countries.

     

    Last paragraph of Discussion: Please highlight the fact that the data quoted from Reference 34 is from Jordan. This will enhance its significance in the context of your article.

     

    Conclusion: Brief recommendations for the empirical treatment of community-acquired UTI in Jordanian patients on the basis of your findings will be very useful. If you could give separate recommendations for different risk groups, that would be even better.

     

    Kind regards and best wishes,

     

    Sincerely

     

    Biswaroop Chatterjee

     

    Point 7: The article could be shortened with a little bit of effort.

     

     

     

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    Yes
  • References:
    B Chatterjee, S Kulathinal, A Bhargava, Y Jain, R Kataria ANTI-MICROBIAL RESISTANCE STRATIFIED BY RISK FACTOR AMONG ESCHERICHIA COLI STRAINS ISOLATED FROM THE URINARY TRACT AT A RURAL CLINIC IN CENTRAL INDIA Indian Journal of Medical Microbiology, (2009) 27(4): 329-34
  • Experience and credentials in the specific area of science:

    Worked for a long time in a rural area monitoring antimicrobial resistance patterns in community-acquired infections, including UTIs.

  • How to cite:  Chatterjee B .Review of [Review of the article 'Community-Acquired Urinary Tract Infections in a Rural Area: Predominant Uropathogens, and their Antimicrobial Resistance ' by Batchoun R].WebmedCentral 2011;2(1):WMCRW00343
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1 Is the subject of the article within the scope of the subject category? Yes
2 Are the interpretations / conclusions sound and justified by the data? Yes
3 Is this a new and original contribution? No
4 Does this paper exemplify an awareness of other research on the topic? No
5 Are structure and length satisfactory? Yes
6 Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience? No
7 Can you suggest any reductions in the paper, or deletions of parts? Yes
8 Is the quality of the diction satisfactory? No
9 Are the illustrations and tables necessary and acceptable? Yes
10 Are the references adequate and are they all necessary? Yes
11 Are the keywords and abstract or summary informative? Yes
  • Other Comments:
    1. Grammar should be reviewed by another author.
    2. Although it is involved in the title, there is no information about resistance of uropathogens in abstract.
    3. Candida prevalance is higher than expected in community acquired urinary infections and it concerns suspicion about diagnosis.
    4. Community acquired urinary infection diagnosis was made when / where? It should be indicated in the method section.
    5. Underlying disease was mentioned in the method section but there was no information about it in results. Also prior hospitalization was not investigated.
    6. It should be mentioned that what “ prior antibiotic usage “ is.
    7. The number of lower and upper urinary infections were not mentioned.
    8. It could not be understood that whom the control group was consisted of when risk factors for community acquired infections were determined.
    9. Relapse should be defined clearly in the material and method section.

         10.  The differentiation of colonization, contamination and infection definition was not made. 

     

  • Competing interests:
    No
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    Yes
  • References:
    Med Sci Monit 16(5):CR246-51 (2010) Antibiotic resistance in community-acquired urinary tract infections: prevalence and risk factors. Behice Kurtaran, Aslihan Candevir, Yesim Tasova, Filiz Kibar, Ayse Seza Inal, Suheyla Komur and Hasan Salih Zeki Aksu
  • Experience and credentials in the specific area of science:

    Antibiotic resistance in community-acquired urinary tract infections: prevalence and risk factors.

  • How to cite:  Kurtaran B .Community-acquired urinary tract infections in a rural area in Jordan: Predominant pathogens, and their antimicrobial resistance[Review of the article 'Community-Acquired Urinary Tract Infections in a Rural Area: Predominant Uropathogens, and their Antimicrobial Resistance ' by Batchoun R].WebmedCentral 2011;2(1):WMCRW00332
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