Review for 10.1186/s12876-022-02587-1 (2022)

Title: ANTIBIOTIC USE IN GASTROINTESTINAL SURGERY PATIENTS AT A
VIETNAMESE NATIONAL HOSPITAL
Version: 3 Date: 17 Oct 2022
Reviewer's report:
"PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: Overall the authors did a great job to respond to the comments,
although there are some new ones that must be address.Abstract
• Please determine when the study was conducted.
• Inclusion criteria
Methods
• Was it descriptive cross-sectional or just cross-sectional? There is a discrepancy between what
you mentioned in the abstract and the method.
• Based on your objectives the study outcome should include the appropriateness of antibiotics.
Results
• You mentioned in the abstract that Most surgeries (89.3%) were clean-contaminated
procedures, while in the main text you said “Most patients underwent clean or clean-
contaminated surgery (94.7%)” which one is correct?
• In table no 3 and in the main text you need to calculate the overall appropriateness of
prophylactic antibiotics based on a denominator of less than 106 surgical procedures as you have
missing data on some parameters of evaluation.
• Really, no need for table 5.
Discussion:
• In the first paragraph
In our study, patients’ mean age was 59.7 ± 17.2 years, with > 33% of patients aged > 65
years. Advanced age is a risk factor for postoperative infection and malnutrition15-19. Most
surgeries in the study were classified as clean-contaminated (89.3%) procedures. Cancer was
the predominant indication for surgery (42%), and interventional colonic surgery accounted
for the largest percentage (35.7%) of all operations. According to Altemeier's surgical wound
classification based on the risk of surgical infection, the risk of postoperative infection was
as follows: 1–5% (clean incisions), 5–10% (clean-contaminated incisions), 10–15% (infected
incisions), and > 25% (dirty incisions)20. A cohort study showed that the rate of postoperative
infection was 5.9% in cases of clean open surgery and 46.4% and 3.2% in open and laparoscopic
clean-contaminated surgery, respectively16.
Please present only the results related to wound infection just and support your finding with
what you have mentioned from reference 16. The rest seems like a repetition of the results.
• Why did you mention
Most patients were prescribed a single prophylactic antibiotic (76.3%). Commonly used
prophylactic antibiotics include cefoxitin (49.5%), ceftriaxone (6.2%), and cefazolin (9.3%).
Did you forget to discuss this finding? If have nothing to discuss, please remove it.
• What did you mean by
Statistical evidence suggests that cefoxitin and metronidazole constitute a high percentage of
prophylactic antibiotics administered for gastrointestinal surgery.
• “In fact, prophylactic combination therapy using cefoxitin and metronidazole is widely used
during gastrointestinal surgery for effective coverage against anaerobic bacteria, although this
combination is not reasonable”
This should go above where you reported the finding that “Most patients in our study received
prophylactic cefoxitin (64.2%) and metronidazole (21.7%).
• In general, when you compare the percentage from other studies to compare the rate of infection
or appropriateness of antibiotics you must add information about what were the types of surgical
procedures studied by other researchers otherwise your comparison is not valid unless the types
of surgical procedures are similar to your included ones.
Conclusions
• You should mention the results of the appropriateness of prophylactic and postoperative
antibiotics as it was the main issue in this manuscript.
General:
• There are some typo or spelling errors
REQUESTED REVISIONS:
Abstract
• Please determine when the study was conducted.
• Inclusion criteria
Methods
• Was it descriptive cross-sectional or just cross-sectional? There is a discrepancy between what
you mentioned in the abstract and the method.
• Based on your objectives the study outcome should include the appropriateness of antibiotics.
Results
• You mentioned in the abstract that Most surgeries (89.3%) were clean-contaminated
procedures, while in the main text you said “Most patients underwent clean or clean-
contaminated surgery (94.7%)” which one is correct?
• In table no 3 and in the main text you need to calculate the overall appropriateness of
prophylactic antibiotics based on a denominator of less than 106 surgical procedures as you have
missing data on some parameters of evaluation.
• Really, no need for table 5.
Discussion:
• In the first paragraph
In our study, patients’ mean age was 59.7 ± 17.2 years, with > 33% of patients aged > 65
years. Advanced age is a risk factor for postoperative infection and malnutrition15-19. Most
surgeries in the study were classified as clean-contaminated (89.3%) procedures. Cancer was
the predominant indication for surgery (42%), and interventional colonic surgery accounted
for the largest percentage (35.7%) of all operations. According to Altemeier's surgical wound
classification based on the risk of surgical infection, the risk of postoperative infection was
as follows: 1–5% (clean incisions), 5–10% (clean-contaminated incisions), 10–15% (infected
incisions), and > 25% (dirty incisions)20. A cohort study showed that the rate of postoperative
infection was 5.9% in cases of clean open surgery and 46.4% and 3.2% in open and laparoscopic
clean-contaminated surgery, respectively16.
Please present only the results related to wound infection just and support your finding with
what you have mentioned from reference 16. The rest seems like a repetition of the results.
• Why did you mention
Most patients were prescribed a single prophylactic antibiotic (76.3%). Commonly used
prophylactic antibiotics include cefoxitin (49.5%), ceftriaxone (6.2%), and cefazolin (9.3%).
Did you forget to discuss this finding? If have nothing to discuss, please remove it.
• What did you mean by
Statistical evidence suggests that cefoxitin and metronidazole constitute a high percentage of
prophylactic antibiotics administered for gastrointestinal surgery.
• “In fact, prophylactic combination therapy using cefoxitin and metronidazole is widely used
during gastrointestinal surgery for effective coverage against anaerobic bacteria, although this
combination is not reasonable”
This should go above where you reported the finding that “Most patients in our study received
prophylactic cefoxitin (64.2%) and metronidazole (21.7%).
• In general, when you compare the percentage from other studies to compare the rate of infection
or appropriateness of antibiotics you must add information about what were the types of surgical
procedures studied by other researchers otherwise your comparison is not valid unless the types
of surgical procedures are similar to your included ones.
Conclusions
• You should mention the results of the appropriateness of prophylactic and postoperative
antibiotics as it was the main issue in this manuscript.
General:
• There are some typo or spelling errors
ADDITIONAL REQUESTS/SUGGESTIONS:
No"