PONE-D-21-22640

Epidemiology, etiology, and diagnosis of health care acquired pneumonia including ventilator-associated pneumonia in Nepal

PLOS ONE

Dear Dr. Karkey,

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Please, revise the manuscript paying special attention to the various suggestions provided by reviewer 2 and resubmit as early as your convenience

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Monica Cartelle Gestal, PhD

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: All abbreviations in the text must be spelled correctly (first in full).

English grammar needs to be revised.

CFU / ml must be spelled correctly in the text.

The sample was collected between 2016-2018, but the methods used CLSI 2016, this is a problem.

What is the meaning of CONS(coagulase-negative staphylococci)? Please refer to it in Table 5.

In the first paragraph of the discussion, it is better to first explain about health care acquired pneumonia.

Reviewer #2: The study is very interesting ; results and conclusion are very useful mainly in this part of world with low resources setting. Authors have clearly discussed pneumonia among patients in ICU; compared according to intervention done. Simliarly, VAP incidence, mortality, etiological agents , Antimicrobial susceptibility tests and other clinical profiles were the items thoroughly discussed in the study. The author also suggests different control measures and preventive strategies. Overall, the paper is good quality but some shortcomings need to be addressed

In abstract

Only add about the main aim of study not all and present in the results serially.

Introduction

The authors have put excellent effort to justify the rationale and background behind the problem.

Methods

The authors have done well in describing methodology under different headings. It would be great if you could further clarify inclusion and exclusion criteria.

Results

The authors have documented the results well mainly for association of intubation and pneumonia.

Discussion

It is good that you have tried to compare data of Nepal mainly VAP density with other Asian countries and LMICs. It would be nice to elaborate causes for contrasting results among these countries??

Why contrasting findings were seen among your study and other western countries study. What might be the likely cause for low numbers of gram positive organism?

As Nepal is poor in economy, please add some cost-effective control and preventive measures of HAP and VAP.

As the outcomes are relevant , possible description of risk factors of VAP in country like Nepal can also be included.

Are ventilator care bundles used in your study site?

Please add any strengths and limitations above conclusion in your study if any.

Minor issues

Spacing not done in some places like line no. 58

Referencing no. Should be after full-stop.

In table 1, write unit of weight , age

Page 266 to 230 n"=" is missing

And also Page 277 to 280 ; and other lines.

Brackets are only open or only closed some where.

Table 4 and 5 can be merged into a single table.

Correct typographical errors.

Thank you!

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: vap.docx

Epidemiology, etiology, and diagnosis of health care acquired pneumonia including ventilator-associated pneumonia in Nepal

PONE-D-21-22640R1

Dear Dr. Karkey,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Monica Cartelle Gestal, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: The authors have address all the queries. Congratulations! on publication og article. This article address major issue in developing countries like Nepal.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: Yes: Sanjeev Kharel