PONE-D-24-54026The global burden of Klebsiella pneumoniae associated lower respiratory infection in 204 countries and territories, 1990–2021: fndings from the Global Burden of Disease Study 2021PLOS 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: Partly

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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: Yes

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:  The authors summarize the global epidemiological burden of lower respiratory infections (LRI) attributable to Klebsiella pneumoniae from 1990 to 2021, using data from the Global Burden of Disease Study. This reviewer considers this study analyze data that completely support the conclusions, with an appropiate statistical analysis. This analysis encompasses the incidence of Klebsiella infections in the respiratory tract in a broad and complete manner.

Reviewer #2:  This study investigates the global epidemiological burden of lower respiratory infections attributable to Klebsiella pneumoniae from 1990 to 2021, using data from the Global Burden of Disease Study (GBD) 2021.

The information presented in the manuscript is relevant, as it highlights the reduction in Klebsiella pneumoniae-associated LRI burden as well as the mortality caused by these bacteria from 1990 to 2021 around the world.

However, the way it is presented is too confusing and the wording of the manuscript is difficult to follow. Specific comments cannot be made because there is no numbering on each line of the manuscript, different font and paragraph styles are observed. Scientific names are misspelled (without italics), there are spaces between sentences and the tables have abbreviations that have no meaning in the text (for example, ASR).

In addition, the manuscript describes two objectives:

“This study aims to evaluate the trends and disparities at global, regional, and national levels, with a particular focus on Klebsiella pneumoniae” and “this study aims to provide a comprehensive analysis of the epidemiology of KP-associated LRIs from 1990 to 2021.”

I consider that the second objective is the one that defines the work carried out since the first one mentions that it evaluates the trends and disparities at global, regional, and national levels, with a particular focus on Klebsiella pneumoniae, when in reality it only focuses on K. pneumonia and not on other bacterial species.

Moreover, mentions the same results in different paragraphs,

“…Conversely, the regions with the lowest age-standardized DALYs and death rates of LRI attributable to Klebsiella pneumoniae were Australasia, High-income North America, Eastern Europe and East Asia…”

“… the most pronounced decreases in DALYs and death cases of LRI attributable to Klebsiella pneumoniae were observed in East Asia, whereas Southeast Asia, Southern Latin America, and Central Europe showed the most significant increases…”.

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Reviewer #1: No

Reviewer #2: No

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The global burden of Klebsiella pneumoniae associated lower respiratory infection in 204 countries and territories, 1990–2021: fndings from the Global Burden of Disease Study 2021

PONE-D-24-54026R1

Dear Dr. Kaizhi Zhi Xu,

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,

Victoria Pando-Robles, Ph.D.

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: The objective has been reworded to explicitly state that the study focuses on Klebsiella pneumoniae-associated LRIs rather than implying an evaluation of multiple pathogens. The relevant revision has been made in lines 51-55 of the introduction section

Reviewer #2 Answer:

The modified target is actually on lines 45-46.

“This study aims to evaluate the global, regional, and national burden of Klebsiella pneumoniae-associated LRI from 1990 to 2021””

Reviewer #2 Comments:

Line 46. Delete comma

The manuscript has been corrected. The data presented on the global epidemiological burden of lower respiratory infections (LRI) attributable to Klebsiella pneumoniae from 1990 to 2021 are sound and supported by the analyses performed.

I recommend the manuscript for publication.

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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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