PONE-D-24-26487Risk and outcomes of healthcare-associated infections in three hospitals in Bobo Dioulasso, 2022 (Burkina Faso): a longitudinal studyPLOS ONE

Dear Dr. HEMA,

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 carefully revise your manuscript according to the reviewers’ comments below. Please also consider the following comment: The percentage of preventable HAI mentioned in the abstract and introduction as well as the references used to support this is debatable. Please delete this statement from the abstract. Please revise the statement in the introduction and considere the following aspects: A publication form Germany https://www.sciencedirect.com/science/article/pii/S0720337310001130?via%3Dihub suggests that only 30% of HAI are being preventable by hygiene measures while an US-American study suggests different proportions for different HAI types (65 – 70% for CABSI / CAUTI, 55% for VAP and SSI, https://pubmed.ncbi.nlm.nih.gov/21460463/ .   Please re-check the references you used. Line 50: Please correct "ESBL" producer. 

Please submit your revised manuscript by Nov 23 2024 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,

Luisa Anna Denkel

Academic Editor

PLOS ONE

Journal Requirements:

1. When submitting your revision, we need you to address these additional requirements.

Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at 

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and 

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. We suggest you thoroughly copyedit your manuscript for language usage, spelling, and grammar. If you do not know anyone who can help you do this, you may wish to consider employing a professional scientific editing service. 

The American Journal Experts (AJE) (https://www.aje.com/) is one such service that has extensive experience helping authors meet PLOS guidelines and can provide language editing, translation, manuscript formatting, and figure formatting to ensure your manuscript meets our submission guidelines. Please note that having the manuscript copyedited by AJE or any other editing services does not guarantee selection for peer review or acceptance for publication. 

Upon resubmission, please provide the following:

The name of the colleague or the details of the professional service that edited your manuscript

A copy of your manuscript showing your changes by either highlighting them or using track changes (uploaded as a *supporting information* file)

A clean copy of the edited manuscript (uploaded as the new *manuscript* file)

3. In the online submission form, you indicated that The datasets, including deidentified provider quantitative and qualitative data, used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

All PLOS journals now require all data underlying the findings described in their manuscript to be freely available to other researchers, either a. In a public repository, b. Within the manuscript itself, or c. Uploaded as supplementary information.

This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If your data cannot be made publicly available for ethical or legal reasons (e.g., public availability would compromise patient privacy), please explain your reasons on resubmission and your exemption request will be escalated for approval. 

4. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section. 

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

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: Partly

**********

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

Reviewer #1: I Don't Know

Reviewer #2: N/A

**********

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: No

**********

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: Yes

Reviewer #2: No

**********

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:  The Title: The use of parentheses in this title is inconvenient.

Ligne 36 et 92, 131, 136 : Correct writting of dates (superscripts). Also review the entire text.

Line 37: Define the abbreviation DO or write it as the name (Do). Harmonize writing throughout the text.

Line 87: Risk factors (in the title) or etiological factors (as aim): For me, It seems that the terms can be nuanced.

Line 185: Sentence to be reviewed.

Lines 199 and 350 (ethical aspects): the reference number of the national ethics committee must be mentioned.

If you say: "We obtained informed consent, written and signed from parents or guardians for minors", please also specify if the consent of minors has also been obtained.

Table 3: cOR and aOr must be defined in the legend.

Line 244 (point 3.3): Why were the proportions estimated based on 45 microorganisms instead of the 47 identified?

Lines 243 and 306: How was the selection of HAIS for bacterial identification made (79 out of 166)?

Enterobacteriaceae, Enterobacteria: Review use in context.

Lines 292 -305: A clearer explanation of the incidence found can be made as you have just made comparisons but without explaining why the difference in results observed. Is the comparison made with prevalence or incidence studies?

Moreover, for the articles with which the comparison is made, it would be preferable to put the results found instead of just quoting the articles in question (lines 292 -305 and 306-315).

Ligne 303“The lack of infection control policies and trained personnel and the overcrowding of our hospitals may explain the high incidence of HAIs in our study” This aspect was not mentioned in the results section.

Line 326-334 (penultimate paragraph of the discussion): You have mentioned the first and last names of the authors as references, which should not be the case. Please refer to the authors' guide for references in the body of the text.

In conclusion: You conclude that the incidence is high. Are there any acceptable thresholds?

Why separate enterobacteria from gram-negative bacilli in Figure 2?

Reviewer #2:  General comments

Thank you so much for the opportunity to review this manuscript. It presents an interesting and important study on healthcare-associated infections (HAIs) in three hospitals in Burkina Faso, a region in West Africa that faces significant healthcare challenges, including HAIs. While the study addresses a critical need for data from resource-constrained settings, several areas require substantial revisions to improve the quality and clarity of the research presentation.

Major comments

1. Language and grammar

i. It would be beneficial to have the entire manuscript reviewed by a native English speaker or a professional editor, as there are numerous grammatical errors, spelling mistakes, inconsistent use of abbreviations and unnecessary use of bullet points (e.g., "May 1th" should be "May 1st") that distract the reader.

2. Abstract

i. In the "Results" section, clarify the statistical significance (e.g., p-values) of the associations mentioned.

3. Materials and Methods

i. Study design: Consider changing the "Study design and location" subtitle to simply "Study design" and ‘‘setting’’. Clearly outline the longitudinal, multicentre nature of the study upfront.

ii. Sampling: I suggest that the authors should include a detailed description of the sampling methods. Currently, the focus is on the wards surveyed without explaining the rationale for choosing these wards – this need to be addressed

iii. Use "exclusion criteria" instead of "non-inclusion criteria." Additionally, avoid using bullet points when describing inclusion and exclusion criteria, as this can distract the reader. These sections should be revised.

iv. Surveillance and data collection: Define the operational definitions from the French Technical Committee more clearly. What kind of modifications were made to the operational definitions? This need to be explained.

v. Provide more clarity on the method used for identifying cases and how the study ensured the reliability of data collection.

vi. Data analysis: Specify the software versions used for statistical analysis. Clarify the process by which the significance threshold was set at p < 0.05.

vii. HAI classification: The manuscript mentions targeting specific infections like SSIs and neonatal infections. However, there is a need to provide more detail about how these infections were classified and confirmed.

viii. Outcomes: The discussion around HAI outcomes, such as length of stay, needs to address the potential biases and limitations in data collection and interpretation.

4. Results

i. Presentation: Replace terms like "third of the sample" with specific numbers and percentages to ensure clarity.

ii. Analysis of subgroups: Provide a more detailed breakdown of HAI data by age group, sex, and hospital ward. Consider reorganising the data to separately present outcomes for children and adults.

iii. Incidence rates: The text should clarify whether the reported incidence density rates are crude or adjusted. Additionally, describe how these rates compare to those found in other regional studies to add context.

5. Discussion

i. The discussion should be rewritten using a standard scientific format, including a comparison with previous research and an exploration of potential reasons for the differences observed in this study.

ii. Avoid repetition of results in the discussion section.

iii. The recommendations section seems overly general. It would benefit from being directly linked to the study's results to provide more actionable insights for healthcare facilities in similar settings.

6. Ethics statement

i. Expand on the ethics approval process, including the measures taken to protect patient confidentiality and the consent procedure for different age groups (especially neonates).

7. Conclusions

i. While the conclusions section appropriately summarises the key findings, it should be slightly expanded to include more specific recommendations for policy and practice based on the study’s results.

Specific comments

i. Page 4, Line 66: Consider revising to "…HAIs are caused by bacteria, viruses, or fungi that develop resistance..." and the statement should be supported with a reference.

ii. Page 9, Line 162-163: Provide more detail on how operational definitions were modified for this study. Modified operational definitions can be provided as an appendix.

iii. Clarify how patient residence (urban/rural) might influence HAI risk.

Recommendations

i. Restructure the methods section: Clearly define study design, setting, data collection, and analysis to facilitate reproducibility.

ii. Data analysis: Expand the data analysis section to include more in-depth explanations of the statistical methods used.

iii. Supplementary materials: Include more detailed information in the supplementary materials if some content (e.g., specific diagnostic criteria) makes the main text too dense.

Best wishes!

**********

6. 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: Yes:  Dr Tani SAGNA

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: Reviewers comments.docx

<div>PONE-D-24-26487R1Risk and outcomes of healthcare-associated infections in three hospitals in Bobo Dioulasso, Burkina Faso, 2022: a longitudinal studyPLOS ONE

Dear Dr. HEMA,

Thank you for re-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 consider the final suggestions made by reviewer 2 to further improve the quality of your work. 

Please submit your revised manuscript by Jan 10 2025 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,

Luisa Anna Denkel

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.

[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

Reviewer #2: (No Response)

**********

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

Reviewer #2: Yes

**********

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

Reviewer #1: I Don't Know

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 #1: Yes

Reviewer #2: 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

Reviewer #2: No

**********

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: (No Response)

Reviewer #2: I would like to commend the authors for their efforts in addressing most of the issues raised earlier, which is highly commendable. However, I believe there is still room for improvement, particularly in refining the language to enhance clarity and flow. Below are some minor issues that could serve as a guide to address areas that have not been adequately resolved, which will improve the manuscript.

1. Writing numbers in scientific writing

In scientific writing, numbers from one to nine are typically written out in words (e.g., one, two, three) rather than as numerals (e.g., 1, 2, 3). Numbers 10 and above should be written as numerals (e.g., 10, 11, 20, etc.). Therefore, the notation such as ‘four (04)’ is redundant and should be simplified to just "four." This should be corrected throughout the manuscript.

2. Lines 124-126

The sentences ‘In 2022, the gynecology and obstetrics postoperative care ward of Sourô Sanou Teaching Hospital received 1,946 women, including 1,433 cesareans. This unit has 30 inpatient beds. The staff consisted of 16 physicians, four (04) nurses and 21 midwives.’ This can be improved as follows:

• As earlier noted, numbers between 1 and 9 should be written out in full, so "four (04) nurses" should simply be "four nurses" to avoid unnecessary distractions.

• The phrase "including 1,433 cesareans" is unclear. It might imply that all 1,946 women had cesareans, but the word "including" suggests a subset. To improve clarity, I would rephrase it to something like:

‘In 2022, the gynecology and obstetrics postoperative care ward of Sourô Sanou Teaching Hospital treated 1,946 women, 1,433 of whom had cesarean sections. The unit has 30 inpatient beds and a staff of 16 physicians, four nurses, and 21 midwives.’

Note: this is just an example

3. Lines: 152-156

The sentence ‘Information collected from these sources was supplemented by information from patients and nursing staff and recorded on individual data collection sheets which included, among others: socio demographic data (age, sex, origin, profession), factors risk related to care, initial or curative antibiotic therapy, HAI type, pathogen in question, development.’

• The phrase "factors risk related to care" is grammatically incorrect. It should be revised to something like "risk factors related to care."

• The sentence is quite long and could benefit from breaking it into two sentences to improve readability

• The phrase "included, among others" could be revised for conciseness to just "included." The reader will infer that the list is not exhaustive.

• The word "development" is vague. Specify whether it refers to patient outcomes, the progression of an infection, or something else.

4. In line 261-265

• Like other bacteria listed out the Escherichia coli should be italicized

• Use "spp." for species abbreviation and correct "spp1" to spp (Pantoea spp1)

• Use ‘spp’ instead of ‘sp’ (Enterococcus sp)

5. Discussion: The discussion section still contains repeated results, particularly in the first and second paragraphs, which is unnecessary. The discussion should focus on interpreting and analyzing your findings rather than restating them. While it is acceptable to highlight key results, summarizing the entire results in this section is not ideal. Please revise to ensure the discussion provides meaningful insights and context for your results.

6. Line 328: The abbreviation ‘AIS’ is not defined anywhere in the manuscript, if it refers to HAIs kindly correct it.

7. Lines 344-346: ‘Systematic empirical antibiotic therapy, whether prophylactic or curative, sometimes prior to bacterial culture, a common practice in the neonatal ward, could explain the poor performance of culture in our study.’

It is important to note that requesting a bacterial culture before surgical prophylaxis is unnecessary. Antibiotic use can generally be categorized into three main indications: empiric, targeted/definitive, and prophylactic. Prophylactic antibiotics are typically guided by the type of surgical wound (clean-contaminated or contaminated) and the likely pathogens expected during the procedure. There is ongoing debate about the necessity of prophylactic antibiotics in clean wounds, while for contaminated wounds, prophylaxis is not indicated because these wounds require treatment for an established infection. As such, obtaining a bacterial culture is not a prerequisite for surgical prophylaxis, which is specifically intended to prevent infections from anticipated pathogens rather than treat an existing one. I would suggest you revise the sentence to something like:

‘The poor performance of culture in our study could be explained by the common practice in the neonatal ward of initiating systematic empirical antibiotic therapy, prior to obtaining bacterial cultures.’

Note: This is just an example

8. Lines 358-359: ‘However, differences between men and women in terms of personal hygiene practices, of comorbidities frequency and anatomy may explain this association.’

• The phrase "in terms of personal hygiene practices, of comorbidities frequency and anatomy" is cumbersome and could be streamlined for better clarity.

• The phrase "comorbidities frequency" should be "the frequency of comorbidities" for proper grammar

I would revise the sentence as ‘However, differences between men and women in terms of personal hygiene practices, the frequency of comorbidities, and anatomy may explain this association.’

Note: This is just an example

Best of luck

**********

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

Reviewer #2: Yes:  Muhammad Augie Bashar

**********

[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: Recommendations.docx

PONE-D-24-26487R2Risk and outcomes of healthcare-associated infections in three hospitals in Bobo Dioulasso, Burkina Faso, 2022: a longitudinal studyPLOS ONE

Dear Dr. HEMA,

Thank you for re-submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not (yet) 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 find the issues that need to be resolved below. 

Please submit your revised manuscript by Jan 17 2025 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,

Luisa Anna Denkel

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:

Dear authors,

Thank you for the revision of your manuscript that increased its quality. However, before the manuscript can be accepted for publication, a few more changes are necessary. We hope for your understanding:

1. Please use the term “Enterobacterales” instead of “Enterobacteriaceae” in the entire manuscript.

2. Please always include the country when reporting the study location including the abstract. E.g. -

- […] in three hospitals in the city of Bobo Dioulasso, Burkina Faso.

- A prospective, longitudinal, multicenter study was conducted from May 1 to November 30, 2022, in two district hospitals (Do and Dafra) and the Sourô Sanou Teaching Hospital (CHUSS), Burkina Faso.

3. Most importantly, please explain the fact that LOS > 2 days was identified as risk factor. What was the reference group? This does not make any sense. According to your inclusion criteria LOS > 48h is a prerequisite for inclusion. Please clarify this issue.

4. Please use the term “risk factors” instead of “predictors” and “etiological factors” throughout the entire manuscript. Please explain in methods how the variable “Length of stay before inclusion >2 days” has been defined.

5. Table 3:

- please correct “Length stays before inclusion >2 days” into “Length of stas before inclusion >2 days. Again, what was the reference here?

- Please explain the abbreviation CHUSS in the table legend.

**********************************************************************

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

[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.

Risk and outcomes of healthcare-associated infections in three hospitals in Bobo Dioulasso, Burkina Faso, 2022: a longitudinal study

PONE-D-24-26487R3

Dear Dr. Arsene HEMA,

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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager®  and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, 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,

Luisa Anna Denkel

Academic Editor

PLOS ONE