Title: Clinical features and recurrence of Corynebacterium kroppenstedtii infection in patients
with mastitis
Version: 3 Date: 20 Feb 2022
Reviewer's report:
Zeng  et al. reported a retrospective study on  Chinese patients infected with C. kroppenstedtii
mastitis. This is a large study with 133 patients, however there are several concerned for the
authors.
Major comments:
1. The author want to compare the characteristics between GLM and NGLM, which is not well-
introduced in the manuscript. The author need to explain or give references for the criteria for
diagnosis of granulomatous mastitis and how to differentiate GLM and NGLM. Explain why it
is important to differentiate these two conditions in the introduction and discussion.
GLM should stand for granulomatous lobular mastitis, which should be corrected throughout
the manuscript.
In the method section Line 143, is it true to classified "Other patients diagnosed with mastitis
are classified into the NGLM group". Do they have nonlubolocentric granuloma in all of these
patients?
The term "cystic neutrophilic granulomatous mastitis" should also be introduced in the
introduction as well.
2. Based on the results, it is over-extrapolated to say that "A combination of an antibiotic,
triamcinolone acetonide lavage, preferably cefuroxime, can effectively reduce disease
recurrence." The study design here cannot answer this question and the sample sizes in each
treatment arm does not have enough power to say so. I suggest the authors consider other
sentences that truly reflect the results  in the abstract and conclusion.
Minor comments:
General:
- I am not a native English speaker but I found the manuscript was difficult to follow and need
language editors.
- "antimicrobial sensitivity" should be replaced with antimicrobial susceptibility.
- Genus and species should be italicised.
Abstract:
- Line 44: "antibacterial susceptibility" rather bacterial antibiotic sensitivity.
- Line 49: add fullstops.
- Line 55-56: "Treatment with local lavage (triamcinolone acetonide) and antibiotics
(cefuroxime) showed a lower recurrence rate of C. kroppenstedtii infection (25.9%)." Lower
recurrence rate compare to what?
- Line 58: clarify "different types of mastitis".
- Line 60-61: Please read major comments.
Introduction:
- Line 73: replace "imagingly" with "radiographically.
- Line 88: is "toxicity" refer to "virulence"?
- Line 95: the phrase "mastitis combined with bacillus infection" is rather confusing. Please
specify which bacillus that you want to refer to?
Methods:
- Line 117: I don't think "granulation mastitis" and "granulomatous mastitis" are the same.
- Line 154-159: please do not capitalise drug name. The dosages of some drugs seemed lower
than normal dose i.e. amoxicillin-clavulanate, cefuroxime, cefixime, and levofloxacin. Please
check and confirm the data.
- Line 162: Is it incubated in ambient air or with CO2?
- Line 167: I don't think Fig 2 is needed. Please add version of Bruker's database used and short
described susceptibility tested method and breakpoints (CLSI or EUCAST) used to interpret the
susceptibility testing results.
Results:
- Line 179: "C. kroppenstedtii" instead of "C. klebsiella".
- Line 196-197: Explain what are the meaning of "physical therapy" and "puncture"?
- Line 205: what is c2?
- Line 215-253: Please clarify these lines.
Discussion:
- Line 345-347 and 357-358: Please follow  major comment.
Tables and Figures:
- Figure 2 is no needed.
- Table 1: clarify GLM and NGLM in the footnote of the table.
- Figure 3: Labels and Legends need to be modified.
- Table 3: recurrence
- Table 4: susceptible, intermediate, resistant, and breakpoint. Also expand "MIC" in footnote.