Tracking the Threat, 50 Years of Laboratory-Acquired Infections: A Systematic Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

- The title should include the type of the study and any more related breif details.

- The figure1 should be pie chart

- Replace figure 2 by a table instead.

- Why you did not serach in other platforms like scopus

- Is it possible to prepare PRISMA flow diagram?

- In discussion, SARS-Cov and SARS-cov2  should be included.

DOI: 10.1056/NEJMoa032565 https://doi.org/10.1016/j.infpip.2020.100081

https://doi.org/10.1101/2020.04.07.20055723

Author Response

#1

Comment 1: The title should include the type of the study and any more related breif details.

Response 1: Thank you for the observation, we have modified the title to include that our article is a review, following a similar case that  has already been published at AMH:

Vongsavath, T.; Chun, M.; Tun, K.M.; Manne, V. Clostridioides Difficile Infection-Related Hepatic Abscess: A Review of the Literature. Acta Microbiologica Hellenica 2024, 69, 204–211, doi:10.3390/amh69030019.

Thus, our article’s final title has been modified to: “Tracking the Threat, 50 Years of Laboratory-Acquired Infections: A Review”

#2

Comment 2: The figure1 should be pie chart

Response 2: We appreciate the suggestion, and agree it aids in the data interpretation. Therefore, the change was made as can be observed in lines 144-147.

#3

Comment 3:  Replace figure 2 by a table instead.

Response 3: As mentioned in response #2, we also appreciate this suggestion to aid in data interpretation. Therefore, the change was made as can be observed in lines 159-162.

#4

Comment 4: Why you did not serach in other platforms like scopus?

Response 4: Thank you for raising this important point. Since the last submission, we have included Cochrane in our search strategy due to its specialization in systematic reviews and meta-analyses, which enhances the robustness of our methodology.

Considering the nature of the topic, we believe that the selected databases are appropriate, particularly PubMed, given its extensive coverage of biomedical literature. Additionally, we utilized Google Scholar to capture a broader range of literature across disciplines, including grey literature, and ABSA, which provides a valuable resource with its extensive reports on LAIs worldwide.

To address your concern, we have also clarified in the methodology section why these specific databases were selected to ensure transparency and justify their relevance to the study, specifically in lines 80-86.

#5

Comment 5: Is it possible to prepare PRISMA flow diagram?

Response 5: Thank you for the suggestion, we believe it improves the rigor of the paper’s methodology. Consequently, a short description of the search strategy and the diagram was added in lines 128-137.

#6

Comment 6: In discussion, SARS-Cov and SARS-cov2  should be included.

DOI: 10.1056/NEJMoa032565 https://doi.org/10.1016/j.infpip.2020.100081

https://doi.org/10.1101/2020.04.07.20055723

Response 6: We appreciate the valuable suggestion to include SARS-CoV and SARS-CoV 2 in the discussion. We found the referenced literature highly insightful. Your suggestion helped us better connect the pandemic potential of LAIs, aligning with a recommendation from another reviewer to expand this aspect further.  Therefore, these pathogens are now mentioned in the discussion in lines 271-283.

Reviewer 2 Report

Comments and Suggestions for Authors

The introduction should clearly identify the research gap and emphasize the importance of this study. Why is so much focus placed on the historical context of laboratory-acquired infections when the article is meant to address current global biosafety challenges? The potential pandemic implications of LAIs are mentioned in the introduction and conclusions, but why are they missing from the discussion? Shouldn’t such a critical point be explored in more depth?

The methodology section also raises questions. Why is there no proper justification for the selection of specific databases and keywords? Does relying solely on published data - known to have risks of underreporting- provide a comprehensive picture? This issue is briefly mentioned but not adequately addressed, leaving the methodology lacking in rigor…

Looking at the data presentation, why is redundancy an issue??? The figures while informative lack detailed annotations… How are non-expert readers supposed to interpret them effectively without proper guidance???

 

The discussion is surprisingly weak for a review article... Why does it mainly repeat results instead of providing critical analysis? Shouldn’t the pandemic potential of certain pathogens, highlighted in the introduction, be thoroughly examined? Why are there so few references to existing literature? 

 

The conclusions are another area of concern. Why are they so broad and lacking in actionable recommendations? Instead of vague calls for global collaboration, shouldn’t the authors propose concrete measures, such as international regulatory frameworks for BSL-3 and BSL-4 laboratories?

 

I suggest considering one of the Amir Khorram-Manesh’s works, such as:

https://doi.org/10.1016/j.jiph.2023.10.038

https://doi.org/10.24171/j.phrp.2023.0372

https://doi.org/10.1016/j.jiph.2024.102615

 

These papers analyze weaknesses in current pandemic management systems and emphasize globalized public health and interdisciplinary collaboration. Wouldn’t incorporating insights from these works enrich the discussion by addressing gaps in multi-agency coordination and technological advancements for data sharing? How else can the study link LAIs to broader pandemic preparedness frameworks and global health security?

 

Author Response

#1

Comment 1: The introduction should clearly identify the research gap and emphasize the importance of this study. Why is so much focus placed on the historical context of laboratory-acquired infections when the article is meant to address current global biosafety challenges?

Response 1: We greatly appreciate this suggestion to improve the introduction section. Consequently, the introduction section has been restructured to reduce the historical context of LAIs to address global biosafety challenges and to emphasize the research gap that’s addressed in the article. These changes can be found in lines 32-77.

 #2

Comment 2: The potential pandemic implications of LAIs are mentioned in the introduction and conclusions, but why are they missing from the discussion? Shouldn’t such a critical point be explored in more depth?

Response 2: Thank you very much for this valuable suggestion. We have restructured the discussion to explore the pandemic implications of LAIs further, along with other suggested points, enhancing the richness of the discussion. As part of this restructuring, this point has been expanded and addressed in lines 246-283.

#3

Comment 3: The methodology section also raises questions. Why is there no proper justification for the selection of specific databases and keywords?

Response 3: We appreciate the suggestion, the justification on specific databases and keywords has now been included in lines 82-97 in the methodology section.

#4

Comment 4: Does relying solely on published data - known to have risks of underreporting- provide a comprehensive picture? This issue is briefly mentioned but not adequately addressed, leaving the methodology lacking in rigor…

Response 4: Thank you for raising this point, we understand the concern regarding the potential for underreporting within published data. While we acknowledge this limitation, our decision to focus solely on published reports was driven by the need to ensure a high level of data quality and consistency. We believe that published studies undergo a more rigorous peer-review process, enhancing the reliability of the findings. 

However, we appreciate the insight and have incorporated a statement addressing this limitation in the discussion section, acknowledging the potential for underreporting and discussing its implications on our findings in lines 316-322.

#5

Comment 5: Looking at the data presentation, why is redundancy an issue???

Response 5: Thank you for bringing this to our attention. Regarding redundancy, we are unsure where it was specifically identified as an issue in the data presentation of the initially submitted manuscript. However, we acknowledge that redundancy can become a concern when selecting data from various articles. For instance, multiple individual LAI reports may be referenced in review articles that cover incidents in a specific period. During the literature search, the individual LAI incidents cited in such reviews can appear as well. To avoid the duplication of these records in our data set, these articles are only reported once.

To address this clearly, the methodology section outlines the techniques employed to avoid duplication of records. These details are provided in lines 115–117.

#6

Comment 6: The figures while informative lack detailed annotations… How are non-expert readers supposed to interpret them effectively without proper guidance???

Response 6: We appreciate you raising this point. To improve the interpretation of the article’s figures more detailed descriptions were included in the following lines:

• 136-137
• 145-147
• 159-161
• 191-194
• 206-210

#7

Comment 7: The discussion is surprisingly weak for a review article... Why does it mainly repeat results instead of providing critical analysis? Shouldn’t the pandemic potential of certain pathogens, highlighted in the introduction, be thoroughly examined? Why are there so few references to existing literature? 

Response 7: Thank you very much for this valuable suggestion.  We believe this point has been partly addressed in response to Comment #2. To expand on this, we have restructured the discussion to further explore the pandemic potential of certain pathogens and reduced the repetition of results to provide a more critical analysis. As part of this restructuring, this has been addressed in lines 246-283.

#8

Comment 8: The conclusions are another area of concern. Why are they so broad and lacking in actionable recommendations? Instead of vague calls for global collaboration, shouldn’t the authors propose concrete measures, such as international regulatory frameworks for BSL-3 and BSL-4 laboratories?

Response 8: We appreciate your suggestion. Thus, the conclusion has been modified to specifically comment on actionable recommendations and regulatory frameworks for BSL-3 and BSL-4 laboratories, as shown in lines 324-336.

# 9

Comment 9: I suggest considering one of the Amir Khorram-Manesh’s works, such as:

https://doi.org/10.1016/j.jiph.2023.10.038

https://doi.org/10.24171/j.phrp.2023.0372

https://doi.org/10.1016/j.jiph.2024.102615

These papers analyze weaknesses in current pandemic management systems and emphasize globalized public health and interdisciplinary collaboration. Wouldn’t incorporating insights from these works enrich the discussion by addressing gaps in multi-agency coordination and technological advancements for data sharing? How else can the study link LAIs to broader pandemic preparedness frameworks and global health security?

 Response 9:

 We appreciate this suggestion to improve the overall quality of the discussion. Thank you very much for providing the suggested articles, they provided very valuable perspectives to address the points that you suggested. Therefore, the discussion has been modified to address these points in lines 293-315.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The authors have incorporated all the revisions I suggested. The article now meets the requirements and I recommend its publication.

Author Response

Thank youfor your time and review of our manuscript. We truly appreciate your valuable feedback, which has helped us improve the clarity and quality of our work. We are excited to hear that the revised version meets the journal’s requirements, and we sincerely appreciate your recommendation for publication.