Peer Review History

Original SubmissionFebruary 9, 2022
Decision Letter - Yong-Hong Kuo, Editor

PONE-D-22-04059Global, regional, and the national prevalence of nosocomial infection: A systematic review and meta-analysisPLOS ONE

Dear Dr. Ghashghaee,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Apr 21 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Yong-Hong Kuo

Academic Editor

PLOS ONE

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Additional Editor Comments (if provided):

The manuscript has been reviewed by two experts in the area. Both of them find the significance of the study and are positive about the submission. They have provided constructive and very helpful comments to improve the article. Based on their recommendations and comment, I suggest Major Revision.

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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: Yes

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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: This is an interesting review article and the authors have collected a unique dataset. The paper is generally well written and organized. However, in my opinion, there are some shortcomings. Some sentences are not well structured and do not bring out the argument clearly. What is the impact of this review to the public health? What recommendations do you have for stakeholders and policymakers?

Reviewer #2: This is a large meta-analysis evaluating the global prevalence of Hospital-acquired infection (HAI). This is an important topic, and the manuscript includes interesting data on causative pathogens for HAI globally and prevalence rates of HAI. The main issue with this manuscript is the number of studies and heterogenous data. With the number of studies, it is difficult to draw broad conclusions. HAI can have different definitions between studies, countries, and institutions. Several co-variates based on different healthcare systems may be unaccounted for. For example, it is surprising that duration of hospitalization was not an associated factor with HAI as seen in previous studies. I would consider limiting the number of studies and potentially decreasing the time the studies were conducted over. With less studies, the manuscript could include a more direct summary and comparison of data from studies.

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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 #1: No

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachments
Attachment
Submitted filename: Reviewer comments.docx
Revision 1

Reviews 1 This is an interesting review article and the authors have collected a unique dataset. The paper is generally well written and organized. However, in my opinion, there are some shortcomings. Some sentences are not well structured and do not bring out the argument clearly. What is the impact of this review to the public health? What recommendations do you have for stakeholders and policymakers?

Answer: Nosocomial infection is one of the most important indicators of hospitals to evaluate the performance of the hospital in terms of patient safety. Our study is done on a global scale so it can be very generalizable and help health decision makers to plan to prevent these types of infections. By reducing nosocomial infections, in addition to improving the patient's safety index, a large amount of the costs incurred by the hospital due to these types of infections will be reduced.

We suggest to decision makers that by focusing on different aspects of nosocomial infections such as age, gender, causes, etc. that we mentioned in this study, comprehensive and practical programs can be used to prevent these infections.

Reviews 2 This is a large meta-analysis evaluating the global prevalence of Hospital-acquired infection (HAI). This is an important topic, and the manuscript includes interesting data on causative pathogens for HAI globally and prevalence rates of HAI. The main issue with this manuscript is the number of studies and heterogenous data. With the number of studies, it is difficult to draw broad conclusions. HAI can have different definitions between studies, countries, and institutions. Several co-variates based on different healthcare systems may be unaccounted for. For example, it is surprising that duration of hospitalization was not an associated factor with HAI as seen in previous studies. I would consider limiting the number of studies and potentially decreasing the time the studies were conducted over. With less studies, the manuscript could include a more direct summary and comparison of data from studies.

Answer: We explained in the inclusion and exclusion criteria that we only included studies that provided a clear definition of nosocomial infections. On the other hand, the main purpose of our study was to examine the trend of nosocomial infections in the new century, so if the number of articles is reduced, the main purpose of the article will change.

In relation to heterogeneity, we used subgroup analyzes to solve this problem, which were significantly more efficient.

Reviewers Comments Make the title more concise. National and regional prevalence? We changed it to : Global prevalence of nosocomial infection: A systematic review and meta-analysis

Reviewers Comments Results: AFR higher in Central Africa than the world. By how much? We wrote this information in full in the original version of the article, but in the submitted version we had to make corrections due to the word limit.

We added : 0.27 (95% CI, 0.22-0.34)

Reviewers Comments Besides E. coli infected patients…which other microorganisms are you comparing? We added: such as Coagulase-negative staphylococci, Pseudomonas aeruginosa and Staphylococcus spp.

Reviewers Comments Conclusion. Managers? What is their role? Hospital managers and health policy makers

Reviewers Comments Rephrase last sentence in first paragraph. Not clear.

Thus, by preventing the prevalence of HAIs instead of allocating hefty sums to the treatment of such infections, managers of healthcare centers can bear much lower costs to manage HAIs. Therefore, by preventing and reducing nosocomial infections, significant savings will be made in the costs imposed on health centers, the health system and society consequently

Reviewers Comments Which studies?

According to studies, the most prevalent causes of HAIs include urinary tract infections (UTIs), respiratory tract infections (RTIs), circulatory system infections, and surgical site infections. We add a reference for this statement.

Reviewers Comments Sentence is hanging

Although a number of studies have been conducted on different parts of WHO regions to determine the prevalence rate of HAIs. Although a number of studies have been conducted on different parts of WHO regions to determine the prevalence rate of HAIs, no systematic review has been conducted globally.

Reviewers Comments You need to show up to which date you acquired the 7031 articles. For future references. between 2000 and June 2021

Reviewers Comments Clarify

Increasing rate of HAIs by 0.06% in abstract or 0.6% in results. 0.06 is correct

Reviewers Comments Italicize scientific names We changed them

Reviewers Comments What could result in high HAIs in central Africa? This may be due to the lack of health facilities and resources in this area. The continent is also facing natural crises such as water shortages and droughts, which in turn are increasing nosocomial infections. On the other hand, economic conditions in this region are one of the most important causes of these infections.

Reviewers Comments Why is S. aureus, P. aeroginosa and Klebsiella the most common HAIs? These three microorganisms, in addition to being easier to transport than others, have significant resistance to antibiotics. On the other hand, they are more resistant to sterilization and disinfection methods than others. Due to these characteristics, these microorganisms have a higher prevalence rate than others.

Reviewers Comments Are there any recommendations? We suggest that researchers work on the gaps in our study. For example, conduct studies in countries where no articles on nosocomial infections have been found. On the other hand, studies on the cause and transmission of these infections can greatly help the health system to reduce these types of diseases.

Reviewers Comments Some studies consider COVID 19 as a nosocomial infection. Why did you exclude it? We did not include Covid-19 disease in nosocomial infections because they have different definitions, and if we included Covid-19 infections in our study, it would falsely increase the prevalence of nosocomial infections in recent years, it would be a significant bias.

Attachments
Attachment
Submitted filename: Response to reviewers.docx
Decision Letter - Yong-Hong Kuo, Editor

PONE-D-22-04059R1Global prevalence of nosocomial infection: A systematic review and meta-analysisPLOS ONE

Dear Dr. Ghashghaee,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Sep 22 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.
If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Yong-Hong Kuo

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

There are still minor concerns from the reviewer. Please address them before the final publication.

[Note: HTML markup is below. Please do not edit.]

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 #1: All comments have been addressed

**********

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 #1: Yes

**********

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

Reviewer #1: 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 #1: Yes

**********

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 #1: Yes

**********

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 #1: This is a well written review paper. The author needs to polish up Discussion section as we do not clearly understand why some microorganisms have a higher prevalence rate as nosocomial infections as compared to others.

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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 #1: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachments
Attachment
Submitted filename: renamed_fcd50.docx
Revision 2

Reviews 1 Abstract:

Objectives- Which needs immediate attention. Specific sounds redundant. “ Specific “ was omitted

Reviews 1 Introduction:

Remove the irrelevant sentence-It might happen with any kind of infection.

According to studies- Which ones?

Which studies in Europe? Which countries? Any citations?

In the last paragraph, can is subject to speculation. Replace with will All the comments were corrected

Reviews 1 Results:

Length of stay- Rewrite the first sentence

Countries based on income- Prevalence in high income countries? The first sentence was rewrote.

The prevalence of high-income countries was added

Reviews 1 Discussion-

Why is certain organisms rated as more common HAIs than others? Because these bacteria are more resistant to antibiotics than others.

Reviews 1 Conclusion-

Which gaps? However, several important gaps were identified such as lack of data in different regions and territories and different areas like the cause of HAIs

Attachments
Attachment
Submitted filename: Response to reviewers.docx
Decision Letter - Yong-Hong Kuo, Editor

Global prevalence of nosocomial infection: A systematic review and meta-analysis

PONE-D-22-04059R2

Dear Dr. Ghashghaee,

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.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Yong-Hong Kuo

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Based on the Referees' recommendations, I recommend Accept.

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 #1: All comments have been addressed

**********

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 #1: Yes

**********

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

Reviewer #1: 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 #1: Yes

**********

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 #1: Yes

**********

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 #1: It is an interesting article. This is a comprehensive meta-analysis that looks at the global prevalence of hospital-acquired infections (HAI). This is an essential issue, and the paper contains intriguing statistics on HAI causative microorganisms and HAI prevalence rates throughout the world. Submitted comments have been addressed.

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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 #1: No

**********

Formally Accepted
Acceptance Letter - Yong-Hong Kuo, Editor

PONE-D-22-04059R2

Global prevalence of nosocomial infection: A systematic review and meta-analysis

Dear Dr. Ghashghaee:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Yong-Hong Kuo

Academic Editor

PLOS ONE

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