Comparative Mortality Analysis in Febrile and Afebrile Emergency Department Patients with Positive Blood Cultures: A Retrospective Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This manuscript presents a Comparative Mortality Analysis of Febrile and Afebrile Emergency Department Patients with Positive Blood Cultures, based on a retrospective study. It was conducted at a major Italian university hospital from January 2018 to September 2022 and examined the prognostic significance of fever in patients with bloodstream infections. The authors analyzed positive blood cultures from 1,299 patients, compared the outcomes febrile and afebrile patients at the time of their emergency department admission, and focused on particularly on mortality rates. The authors reported that afebrile patients have higher mortality rates, challenges traditional diagnostic methods and highlighting the need for a broader diagnostic approach when evaluating patients with serious infections.

The authors also emphasized on the importance of thorough patient assessment in the emergency department. Medical practitioners should consider a wide range of symptoms and signs beyond the presence of fever to improve the detection and treatment of bloodstream infections. This comprehensive approach could lead to earlier and more effective interventions, potentially improving patient outcomes. Additionally, this research opens the door for further research to develop more sensitive diagnostic tools and strategies for identifying at-risk afebrile patients. Furthermore, investigating the underlying mechanisms contributing to the absence of fever in severe infections could provide valuable insights into patient management and treatment strategies.

The authors reported that afebrile patients had a significantly higher mortality rate, with the odds ratio for mortality in afebrile patients being much higher compared to febrile patients. This suggests that the absence of fever might be a marker of increased mortality risk, highlighting the complexity of diagnosing bloodstream infections based solely on the presence of fever. Overall, the study emphasizes the role of fever as a diagnostic marker in emergency settings. I recommend to publishing this work in the Microbiology Research Journal. 

Author Response

Thank you for recommending our work for publication in the Microbiology Research Journal. We greatly appreciate the time and attention you dedicated to reviewing our manuscript.

We are pleased that you recognized the importance of our study in highlighting the need for a broader evaluation of patients with bloodstream infections beyond the presence of fever. Our research aims to emphasize that a more comprehensive diagnostic approach can improve the identification and treatment of at-risk patients, especially those who are afebrile.

Your support regarding the significance of our findings on the higher mortality rates in afebrile patients is very encouraging. We fully agree that further research to develop more sensitive diagnostic tools and strategies for identifying at-risk afebrile patients is crucial. Additionally, investigating the underlying mechanisms contributing to the absence of fever in severe infections could provide valuable insights into patient management and treatment strategies.

Once again, thank you for your comments and recommendation. We are confident that the publication of our work will significantly contribute to the scientific and medical community, enhancing clinical practices and outcomes for patients with bloodstream infections.

Best regards

Reviewer 2 Report

Comments and Suggestions for Authors

1. Kindly italicize the bacterial name throughout the text.

2. Change the word “Incidence” to “Prevalence”.

3. It would be better if the Materials and Methods section were written as a subsection number. Kindly provide more details.

4. I am not sure if ethics approval is required or not. Kindly check with the institution board and MDPI instructions.

Good Luck!

Author Response

We would like to extend our sincere gratitude for your thorough and insightful review of our manuscript. Your constructive feedback and valuable suggestions have greatly contributed to improving the quality and clarity of our work.

Comment 1: Kindly italicise the bacterial name throughout the text.
Response: We have corrected the names by writing them in italics as requested

Comment 2: Change the word “Incidence” to “Prevalence”.
Response: We have made corrections as suggested by the reviewer

Comment 3: It would be better if the Materials and Methods section were written as a subsection number. Kindly provide more details.
Response: We have redefined the subsections, hoping to have addressed the reviewer's comments

Comments 4: I am not sure if ethics approval is required or not. Kindly check with the institution board and MDPI instructions.
Response: We have added a special section to the manuscript. lines 376-378

 

Reviewer 3 Report

Comments and Suggestions for Authors

The authors have conducted a descriptive, retrospective study with the aim of assess the prognostic significance of fever, or its absence, in relation to survival outcomes in patients with bloodstream infections identified upon admission to the emergency department between 2018 and 2022. The topic is relevant and useful for the physician. The work is interesting and detailed. The statistical analysis is complete. Only a few observations need to be corrected:

-The title has a misspelled word. Change it to afebrile.

-The bacterial genus and species should be written in italics.

-The objective is written different across the manuscript. I suggest unify the aim of study.

-Page 3, line 108: This data corresponds to the results section of the study.

-The authors have collected clinical and demographic information from patients but there is no indication of approval by the Ethics Committee of the Hospital where they authorize the authors to use private information and relevant data from the patients. (page 3, line 116 and line 129)

-Page 3, line 127: include a reference.

-Page 4: add references for Charlson score and age groups.

-Page 5, line 176: Several results are repeated in text and table 1. I suggest eliminate data duplicated.

-Page 6, line 197: Several results are repeated in text and table 2. I suggest eliminate data duplicated.

Comments for author File: Comments.pdf

Author Response

We would like to extend our sincere gratitude for your thorough and insightful review of our manuscript. Your constructive feedback and valuable suggestions have greatly contributed to improving the quality and clarity of our work.

Comment 1: The title has a misspelled word. Change it to afebrile.
Response: We changed as suggested

Comment 2: The bacterial genus and species should be written in italics.
Response: We changed as suggested

Comment 3:The objective is written different across the manuscript. I suggest unify the aim of study.
Response: Thank you for your comment, we have tried to harmonise the discourse while keeping the aim consistent in the various parts

Comment 4: Page 3, line 108: This data corresponds to the results section of the study.
Response: Thanks for your comment, we have corrected the error 

Comment 5: The authors have collected clinical and demographic information from patients but there is no indication of approval by the Ethics Committee of the Hospital where they authorize the authors to use private information and relevant data from the patients. (page 3, line 116 and line 129)
Response: thank you for highlighting this point. We have added a small section to line 377

Comment 6: Page 3, line 127: include a reference.
Response: We have added the citation

Comment 7: Page 4: add references for Charlson score and age groups.
Response: Thank you for the important comment. Regarding the Charlson score, we used the group categorisation from the original study [1]. Regarding the differentiation of the age groups, the choice was made arbitrarily after collegial discussion with the study group.
[1] Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. doi: 10.1016/0021-9681(87)90171-8. PMID: 3558716.

Comment 8: Page 5, line 176: Several results are repeated in text and table 1. I suggest eliminate data duplicated.
Response: Thank you for the valuable suggestion. The results reported in the text, although partly repeated in the table, have been retained to ensure greater fluidity for the reader

Comment 9: Page 6, line 197: Several results are repeated in text and table 2. I suggest eliminate data duplicated.
Thank you for the valuable suggestion. The results reported in the text, although partly repeated in the table, have been retained to ensure greater fluidity for the reader