Local Treatment of Driveline Infection with Bacteriophages
Round 1
Reviewer 1 Report
This is a rather interesting and informative MS reporting a specific case where an important application of a combination of the antibiotics and a bacteriophage cocktail has been applied successfully to cure a patient suffering an aftersurgery bacterial infection. It seems that it is a very useful publication demonstrating the importance of the phage therapy.
Some small comments that if addressed would improve the submitted manuscript.
- “with an estimated 10^23 bacteriophages on the planet* -> please correct for the following: “There are an estimated 1031 phage particles on the planet [ se the reference: Comeau AM, Hatfull GF, Krisch HM, Lindell D, Mann NH, Prangishvili D. Exploring the prokaryotic virosphere. Res Microbiol. 2008 Jun;159(5):306-13. doi: 10.1016/j.resmic.2008.05.001. Epub 2008 May 29. PMID: 18639443].
- The authors have used phage cocktail (SniPha 360 … of lytic bacteriophages against Escherichia coli, Staphylo-95 coccus aureus, Pseudomonas aeruginosa, Streptococcus pyogenes, Proteus vulgaris, and Proteus mirabilis).
Unfortunately the authors did not know which phages were in this cocktail (lines 163-164, page 5). So, one can wonder why the cocktail used in this medical application was not checked on the cultures of bacteria extracted from the patient tissues (while it has been mentioned later without clear specifications). It seems that the cocktail was effective against Proteus mirabilis but not for the Staphylococcus aureus strain found in the patient. Why did the authors not check which phages were effective on the Staphylococcus aureus bacteria strain found in the infected tissues of the patient before the surgical operation? It seems that this more detail analysis would make the whole treatment significantly more effective. It does not mean that the authors have to redo their experiments for this publication.
However, more information would be helpful for a reader: what has been checked before usage of the phage cocktail and what was useful and how it can be improved in the future. It would be recommended to indicate the type of the Staphylococcus aureus strain found in the patient. More information should be provided where the bacteria were found: was inside of the Gore® Synecore or on its surface?
- Table 1. Susceptibility profile of Proteus mirabilis and Staphylococcus aureus. There is no legend to the Table 1, abbreviations R, S, and I should be explained.
- Lines 71-75 “Additionally, a (F18) fluordesoxyglucose-PET-CT scan of chest and abdomen was performed (Fig1), revealing pathologically increased local metabolic activity of the driveline from the exit point to the entire surrounding subcutaneous adipose tissue up to the abdominal wall muscles. The infection was strictly isolated to the DL exit site without expansion to the pump” duplicate lines 64-68
- The legend for Figure 1 should be extended to provide more details. It was not clear what is a white star in the area outlined with white dashed line. The authors did not show a real graft of the tissues. The tissues have to be labelled. In the text the authors have to provide the information on how this slice have been obtained: devices, which length of the X-rays was used, and software used to obtain sections of the patient body. It seems that the LVAD system was located on the top of the stomach? Why did the authors use the white star instead of showing some real features in tissues? It seems that this section was not from this patient.
- The legend for Figure 2 should be extended to explain where is bacteriophage-rich galenic, what is in green colour, what is it in white colour? How wide was the Gore® Synecore (is it the outer tube?). It seems that an inner diameter of the Gore® Synecore ? Did it had sufficient space to hold the bacteriophage-rich galenic which seems was a bit too big to be fitted into the Gore® Synecore tube. Indication of the sizes would be helpful for readers and further practical usage of this method increasing the impact of this manuscript.
Author Response
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Author Response.pdf
Reviewer 2 Report
many thanks for the submission. The paper is interesting, however 27 references for a case report are too much, please reduce the references.
Author Response
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Reviewer 3 Report
Thank you for the invitation to review this case study. This case represents DLI which was attempted to cure with bacteriophages. This case comes with sense and has a repurposing approach for the management of infection. The authors have stated that the combination of antibiotics, debridement, and local bacteriophage treatment caused the recovery of DLI. I have a few suggestions for this report; please include the literature review of other case studies conducted on a similar topic. There is a need to discuss the possible mechanism of bacteriophages in the treatment of DLI. The authors are requested to emphasize the importance of this study, in the presence of other reports on this topic. What new information has been added to the literature with this study.
Author Response
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Author Response File: Author Response.pdf
