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

Title: ANTIBIOTIC USE IN GASTROINTESTINAL SURGERY PATIENTS AT A
VIETNAMESE NATIONAL HOSPITAL
Version: 1 Date: 08 Aug 2022
Reviewer's report:
"PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
No - there are minor issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are minor issues
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 - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS:
Overall, the manuscript discusses important health topic, however, there are concerns about the
methods that should be clarified
TITLE:
The title should reflect that the study involved auditing antibiotic prophylaxis before surgical
incision and postoperatively.
ABSTRACT:
Background:
Provide information on the national prevalence of these types of surgeries, infection rates, and
the role of antibiotic prophylaxis in the prevention of surgical site infections.
Objectives:
Should be restructured to include auditing antibiotic use for surgical prophylaxis and identifying
the outcomes of surgeries.
Design:
Just the study was cross-sectional no need for (descriptive), please include when the study
was done, define the outcomes, and describe the criteria used for the evaluation of antibiotics
appropriateness.
Results:
You mentioned the overall rate of antibiotic prophylaxis appropriateness was 54.7% the and the
overall rate of the appropriateness of treatment was 38.5%, this is confusing make it clear.
Keyword: Analgesic is not fitting with the study objectives.
INTRODUCTION:
The introduction did include important information about
1- The prevalence of such types of surgeries at the national or international level.
2- Example of rational or malpractice of antibiotics used for surgical prophylaxis at the national
and international level in such types of surgeries.
3- Statement of the study objectives of the study and rationale.
4- In paragraph No 2 'Effective use of drugs'' did you mean antibiotics or all drugs?
5- In paragraph No line 3.  By “Effectiveness of treatment” did you mean treatment or treatment
outcomes?
MATERIALS AND METHODS:
1- Please state the inclusion criteria explicitly “Patients were categorized into the admissions
and invasive abdominal surgery (laparoscopic semi-colon surgery, laparoscopic appendectomy,
laparoscopic gastrectomy, and anal surgery, among other such procedures) groups” is so
confusing.
2- Exclusion: did you include patients with contaminated surgeries?
3- On what criteria did you define the type of surgeries as clean, clean -contaminated?
4- Please explicitly define the study outcomes.
5- Who collected the data?
6- You mentioned something about surgical site infections, please state the reference used to
identify these infections, was it based on the Center of Disease Control (CDC) criteria?
7- You used “Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery)
antimicrobials from either the Vietnam Ministry of Health (2015) or the American Society of
Health-System Pharmacists (2013), why did you use wo guidelines if you have the national one
it is not sufficient.
8- There was a repetition in the methodology part regarding the evaluation of antibiotic
appropriateness. I provided here a link here for an article that you can use as a guide to write the
methodology part more clearly as it is now confusing.  https://link.springer.com/article/10.1007/
s11096-012-9719-y.
9- How did you calculate the sample size?
10-  Please revise the statistical part, usually multivariate linear regression analysis and
Multivariable logistic regression are used to identify predictors of outcome and adjust for
confounders, not the effect of variables on the outcome. (Consult a biostatistician)
Results
1. Please reduce the number of tables to a max of five.
2.
Discussion:
Overall, this part is hard to read, discussing the findings in a row may improve the discussion,
starting with antibiotics for surgical prophylaxis, postoperative use, SSIs, and predictors of the
outcomes.
1. Start the discussion with the main findings.
2. The appropriateness of prophylactic antibiotic use in our study was 97.2%, this was not
mentioned in the results.
3. Statistical findings like OR should not be presented in the discussion part
4. Limitations should not be included in the conclusion part.
REQUESTED REVISIONS:
Overall, the manuscript discusses important health topic, however, there are concerns about the
methods that should be clarified
TITLE:
The title should reflect that the study involved auditing antibiotic prophylaxis before surgical
incision and postoperatively.
ABSTRACT:
Background:
Provide information on the national prevalence of these types of surgeries, infection rates, and
the role of antibiotic prophylaxis in the prevention of surgical site infections.
Objectives:
Should be restructured to include auditing antibiotic use for surgical prophylaxis and identifying
the outcomes of surgeries.
Design:
Just the study was cross-sectional no need for (descriptive), please include when the study
was done, define the outcomes, and describe the criteria used for the evaluation of antibiotics
appropriateness.
Results:
You mentioned the overall rate of antibiotic prophylaxis appropriateness was 54.7% the and the
overall rate of the appropriateness of treatment was 38.5%, this is confusing make it clear.
Keyword: Analgesic is not fitting with the study objectives.
INTRODUCTION:
The introduction did include important information about
1- The prevalence of such types of surgeries at the national or international level.
2- Example of rational or malpractice of antibiotics used for surgical prophylaxis at the national
and international level in such types of surgeries.
3- Statement of the study objectives of the study and rationale.
4- In paragraph No 2 'Effective use of drugs'' did you mean antibiotics or all drugs?
5- In paragraph No line 3.  By “Effectiveness of treatment” did you mean treatment or treatment
outcomes?
MATERIALS AND METHODS:
1- Please state the inclusion criteria explicitly “Patients were categorized into the admissions
and invasive abdominal surgery (laparoscopic semi-colon surgery, laparoscopic appendectomy,
laparoscopic gastrectomy, and anal surgery, among other such procedures) groups” is so
confusing.
2- Exclusion: did you include patients with contaminated surgeries?
3- On what criteria did you define the type of surgeries as clean, clean -contaminated?
4- Please explicitly define the study outcomes.
5- Who collected the data?
6- You mentioned something about surgical site infections, please state the reference used to
identify these infections, was it based on the Center of Disease Control (CDC) criteria?
7- You used “Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery)
antimicrobials from either the Vietnam Ministry of Health (2015) or the American Society of
Health-System Pharmacists (2013), why did you use wo guidelines if you have the national one
it is not sufficient.
8- There was a repetition in the methodology part regarding the evaluation of antibiotic
appropriateness. I provided here a link here for an article that you can use as a guide to write the
methodology part more clearly as it is now confusing.  https://link.springer.com/article/10.1007/
s11096-012-9719-y.
9- How did you calculate the sample size?
10-  Please revise the statistical part, usually multivariate linear regression analysis and
Multivariable logistic regression are used to identify predictors of outcome and adjust for
confounders, not the effect of variables on the outcome. (Consult a biostatistician)
Results
1. Please reduce the number of tables to a max of five.
2.
Discussion:
Overall, this part is hard to read, discussing the findings in a row may improve the discussion,
starting with antibiotics for surgical prophylaxis, postoperative use, SSIs, and predictors of the
outcomes.
1. Start the discussion with the main findings.
2. The appropriateness of prophylactic antibiotic use in our study was 97.2%, this was not
mentioned in the results.
3. Statistical findings like OR should not be presented in the discussion part
4. Limitations should not be included in the conclusion part.
ADDITIONAL REQUESTS/SUGGESTIONS:
No"