Title: Bacterial isolates and antibiotic susceptibility among women with abnormal vaginal
discharge attending the gynecology clinic at a tertiary hospital in south-western Uganda: A cross-
sectional study
Version: 1 Date: 07 Aug 2023
Reviewer:  Charles Okot Odongo
Reviewer's report:
Reviewer comments
Manuscript title: Bacterial isolates and antibiotic susceptibility among women with abnormal
vaginal discharge attending the gyaene clinic …
General comments:
Overall, the study touches on an important topic on women’s health. It was well designed and
executed with appropriate scientific methods and controls. It is also well written, as the authors
went out of their way to provide clarity and detail in reporting their methods and findings. This
is commendable.
There are, however, a few concerns that require clarification as follows:
Methods section:
• It is plausible to think that anaerobic organisms may have contributed to symptoms that
participants presented with. While you have ably described procedures to identify and culture
a range of organisms, this has not been done for anaerobic bacteria. If so, why? If indeed your
methods account for anaerobes, please indicate this with more clarity.
Antibiotic susceptibility testing:
• Part of Line 160 reads thus: “the antibiotic is not known to have gram-negative antibiotic
activity” for clarity of point, I suggest you re-state as follows: “the antibiotic is not active against
gram-negative bacteria”
• Also, ciprofloxacin, the original fluoroquinolone has limited activity against gram-positive
organisms (not active except for Staphylococcus). You stated that ciprofloxacin was tested
against all gram-positive organisms, particularly Streptococcus (where it is clearly not clinically
effective, and neither is it indicated…). Which standards/guidelines directed you as such?
Results and discussion:
• Line 136: please state the period within which this number of participants presented for care
at the hospital ….
• As per results, you were only able to successfully isolate organisms in less than half (107/361)
of the women with abnormal vaginal discharge. You need to explain this discrepancy. Could
you have missed many anaerobic organisms going by your methods?
• Table 3: I find the results for Ciprofloxacin against Strep. agalacteae and Amoxicillin against
Klebsiella pneumoniae doubtful. Please show evidence that these antibiotics are recommended
for testing against these organisms. I presume they’re ineffective and such testing unhelpful.
• Discussion: There is literature to show very high resistance against ciprofloxacin in some
parts of Uganda, especially Kampala area. The high sensitivity to cipro in your findings is very
intriguing and it would be interesting to compare the performance of this drug against other
similar, but non-vaginal, isolates in your hospital in recent time.
• Lines 252-259: The statements here seem to suggest that the spread of antibiotic resistance
depends on the nature of infection one suffers (and therefore, treatment used) and not just by
simple drug exposure regardless of which infection. It is fact that ciprofloxacin is indicated and
widely used to treat UTIs as per the same UCG (citation no.5). It is also fact that UTIs are
more common than abnormal vaginal discharges. This leads me to conclude that there is more
exposure to ciprofloxacin in this community than your statements here suggest. I find this hugely
conflicting. Please comment or re-discuss in light of these facts….