Reviewer's report
Title:Urinary tract infection among Obstetric Fistula Patients at Gondar
University Hospital, Northwest Ethiopia
Version: 1Date:11 October 2013
Reviewer: rahel nardos
Reviewer's report:
Urinary tract infection among Obstetric Fistula Patients at Gondar University
Hospital, Northwest Ethiopia
Biomedical Central
Authors: Yitayih Wondimeneh, Dagnachew Muluye, Abebe Alemu, Asmamaw
Atinafu, Gashaw Yitayew, Teklay Gebrecherkos, Agersew Alemu, Demekech
Damtie and Getachew Ferede BMC Women's Health Research article
Overall, this is a very relevant topic. The findings from this study will add to our
understanding of the prevalence of urinary tract infections in obstetric fistula
patients, the type of bacteria in involved as well as drug susceptibility patterns.
This in turn can influence our therapeutic options. I commend the authors for
taking on this important topic even under circumstances of challenging research
infrastructure.
Major Compulsory Revisions: I recommend extensive editing in grammar and
sentence structure to engage readers in this article. Although the study itself is
sound, I was greatly distracted by the poor grammar and sentence structure. I
recommend the authors have this manuscript edited by a couple of colleagues
who are more proficient in written English. This should be a common practice for
any researcher regardless. This is a constructive criticism meant to highlight the
importance of presentation to get credibility in research.
For Example: second paragraph in the Background section:
“ Since obstetric fistula (OF) is formed most commonly between the bladder and
vagina
(vesicovaginal fistula), the rectum and vagina (rectovaginal fistula), it can cause
incontinence of urine and stool, frequent bladder infections and many of them live
with the condition for several years which may farther predisposed them to health
related problems like urinary tract infections (UTI) [3, 4].”
The sentence starts by talking about obstetric fistula and then half way through ,
it changes to describing the patients without any transition. The sentence is also
very long. Similar examples are pervasive throughout the article.
Minor essential revision:
Methods:
It is unclear when the urine specimen was collected. I am assuming all
participants are post repair patients since they are able to give midstream urine
samples. ( if they are not yet repaired, they will be leaking constantly and thus
will not be able to give urine specimens). Please clarify if this study was done
before or after repair.
If it was done after repair, when was the urine specimen collected? Ie, was it
immediately after their catheters were removed or was it done only if patients
were symptomatic after catheter removal? Did all patients with repair get
catheters (standard of care in general).
If these were all post fistula surgery patients, then all of them must have been
catheterized after their procedure as part of routine post fistula repair protocol.
So not sure why on Table 1, authors report a proportion of participants as having
no history of catheterization.
How were irritative voiding symptoms recorded? I am assuming this is frequency
and urgency symptoms. Did they do bladder diary to document frequency ? Was
a particular screening questionnaire used for this?
If these were all obstetric fistula patients, how come your minimum age for your
range of participants is 3 years old? By definition, a 3 year old could not have
had an obstetric experience.
Results and Statistics:
Great presentation.
Discussion:
In the discussion, I would like to see the following points addressed
1. How many of these patients had asymptomatic bacteurea? Do the authors
recommend antibiotics therapy for patients who are asymptomatic. I bring this up
because the findings seem to indicate a very high rate of multi drug resistant
gram negative strains. If routine antibiotics for asymptomatic patients is the
recommendation, this could worsen the trend of drug resistance making it
impossible to treat these patients when they actually have symptomatic UTI.
2. Based on your study, what would you recommend as the best first line
antibiotics choice for obstetric fistula patients with UTI in light of the fact that most
rural centers may not have access to urine culture to guide therapy?
3. I am not sure if your study actually answered one of your original objectives ,
ie, risk factors for UTI. The suggestion that poor hygiene is the likely factor is not
supported by this study. More likely risk factors such as prolonged
catheterization, presence of urinary retention, urethral instrumentation, poor
immune system, concurrent fecal incontinence that may be seeding to the
bladder etc should be considered and looked at in a systematic way in future
studies.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare I have no competing interests