PONE-D-24-06474Evaluation of the impact of COVID-19 pandemic on hospital admission related to common infectionsPLOS ONE

Dear Dr. Fahmi,

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• Upon revision, please incorporate all comments given by the reviewers and editor.
• Find the PDF attachment and revise it accordingly.

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Academic Editor

PLOS ONE

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"This work was supported by Health Data Research UK (Better prescribing in frail elderly people with polypharmacy: learning from practice and nudging prescribers into better practice -BetterRx) and by National Institute for Health and Care Research (NIHR130581 - Cluster randomised trial to improve antibiotic prescribing in primary care: individualised knowledge support during consultation for general practitioners and patients – BRIT2). DMA is funded by the NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC-2016-003). The views expressed are those of the authors and not necessarily those of Health Data Research UK, the NHS, the NIHR, the Department of Health and Social Care or Public Health England."

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"All authors declare the following: BG and OpenSAFELY has received research funding from the Laura and John Arnold Foundation, the NHS National Institute for Health Research (NIHR), the NIHR School of Primary Care Research, NHS England, the NIHR Oxford Biomedical Research Centre, the Mohn-Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, the Wellcome Trust, the Good Thinking Foundation, Health Data Research UK, the Health Foundation, the World Health Organisation, UKRI MRC, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme; he is a Non-Executive Director at NHS Digital; he also receives personal income from speaking and writing for lay audiences on the misuse of science. AM has received consultancy fees (from https://inductionhealthcare.com) and is member of RCGP health informatics group and the NHS Digital GP data Professional Advisory Group that advises on access to GP Data for Pandemic Planning and Research (GDPPR). For the latter, he received payment for the GDPPR role. "

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Additional Editor Comments:

In your revised manuscript, include the following sections:

-Keywords

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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: No

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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: Yes

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: The manuscript is well-written and scientifically sound.The abstract provides a concise overview of the study's background, methods, results, and conclusions, effectively conveying the key findings of the research. The background succinctly outlines the global challenge of antimicrobial resistance and the impact of the COVID-19 pandemic on antibiotic prescribing practices for common bacterial infections, setting the context for the study.

The methods section provides clear details on the data source, inclusion criteria, and statistical analysis used, demonstrating a rigorous approach to studying the risk of hospital admissions related to common infections. The use of electronic health records from The Phoenix Partnership (TPP) through the OpenSAFELY platform, with approval from NHS England, lends credibility to the study's methodology.

The results section presents key findings regarding infection diagnoses, hospital admissions, and the effectiveness of antibiotics in preventing complications. The inclusion of specific counts of hospital admissions for different infections and the comparison between antibiotic-prescribed and non-prescribed groups adds depth to the analysis. The observed reductions in hospital admission risks for lower respiratory tract infection (LRTI) and urinary tract infection (UTI) compared to upper respiratory tract infection (URTI) provide valuable insights into the differential impact of antibiotic prescribing on infection outcomes.

The conclusions drawn from the study findings are logical and supported by the data presented. The emphasis on the large effectiveness of antibiotics in preventing complications related to LRTI and UTI underscores the importance of targeted antibiotic prescribing practices to mitigate risks of hospital admissions for these infections.

Overall, the abstract effectively communicates the study's objectives, methodology, and key findings, contributing valuable insights into the impact of antibiotic prescribing on hospital admissions for common infections during the COVID-19 pandemic. The findings have significant implications for antibiotic stewardship efforts and healthcare decision-making. However, providing additional context on the limitations of the study and potential implications for clinical practice could enhance the abstract's comprehensiveness.

Reviewer #2: It is essential to investigate the impact of the COVID-19 pandemic on the emergence of new antimicrobial resistance. However, certain revisions are required to the submitted manuscript.

Major comments

#1. In lines 31-32, the authors should incorporate the total number of study participants retrieved to conclude the present result.

#2. In the study population section (in lines; 82-96), the authors ought to present clear inclusion and exclusion criteria for study participants in a separate paragraph.

#3. The statistical methods section stated (in lines 104-144) needs to be re-written in a well understandable manner. It is somewhat too long, the authors should focus on major points.

#4. The authors ought to present the result section (in lines; 145-187) in a separate sub-headings like; Baseline characteristics of study participants, proportion and rates of COVID-19-related hospital admission, hazard ratio results, etc.

Minor comments

- Some references are incomplete and missing volume, issue, or page number. Please revise all the reference sections following PLoS ONE referencing guidelines.

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Reviewer #1: Yes: Doaa Attia

Reviewer #2: No

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Attachments

Attachment

Submitted filename: PONE-D-24-06474.pdf

Evaluation of the impact of COVID-19 pandemic on hospital admission related to common infections: risk prediction models to tackle antimicrobial resistance in primary care

PONE-D-24-06474R1

Dear Dr. Fahmi,

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.

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Kind regards,

Muluneh Assefa

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

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

Reviewer #2: Yes

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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: (No Response)

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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: No

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