Dear Dr. Getie,

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 Jul 03 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Tebelay Dilnessa, MSc

Academic Editor

PLOS ONE

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2. We require the following information in order to proceed with your submission: As you are reporting a retrospective study of medical records or archived samples, please ensure that you have discussed whether all data were fully anonymized before you accessed them and/or whether the IRB or ethics committee waived the requirement for informed consent. If patients provided informed written consent to have data from their medical records used in research, please include this information in the Methods section.

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5. We are unable to open your Supporting Information file “Suporting information.rar”. Please kindly revise as necessary and re-upload.

Additional Editor Comments:

• The paper generally requires intensive revision. That is, it requires a through edition, revision and proofreading in terms of typographically, punctuation and grammatically.

• The background of the abstract was no explanatory.
• The abstract part of study period should be one and remove the other.
• Consistent use of the words/phrases such as drug, antimicrobial or antibiotics is necessary.
• It is better the author use standard form of Gram-positive or Gram-negative
• In the abstract and result, the absolute number (numerator and denominator) is needed together with the percentage. For example, A/B (C%).
• Write the name of the bacteria at its first appearance, no abbreviation is needed; then for the second appearance write the abbreviated form and continue. Here, please rewrite the abstract part.
• Revise also the conclusion based on the findings
• The introduction should be written in terms of burden of bacteria, rationality and objectives of the study.
• The discussion seems like result and requires revision.
• The discussion should be supported by reasons for variation or similarity, not merely comparison.
• Figures should be uploaded in separate file as ‘TIF’ version
• Follow properly the manuscript writing protocol for 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?

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

Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: The author can see the detailed from the attached pdf

The authors should clearly explain what is known and unknown about the study?

On the methodology part you have you used cross sectional study design but I didn’t have seen the elaboration about sampling. Does your study is survey type?

On Operational definitions line 212 to 216 if you think the terms are already known by readers leave it no need of define. But if it is obligated the authors should cite the appropriate reference

Reviewer #2: Thank you for the opportunity to review the manuscript entitled "Antimicrobial resistance profiles of bacterial from clinical specimens in Amhara National Regional State Public Health Institute, Bahir Dar, Ethiopia: a retrospective study". This manuscript addresses the critical issue of antimicrobial resistance (AMR) in a high-burden setting, providing valuable surveillance data from a regional reference laboratory in Ethiopia. The topic is highly relevant globally, particularly for low- and middle-income countries (LMICs) where AMR surveillance is often limited. The retrospective study design and data from clinical specimens over a 2.5-year period offer insight into local resistance trends that can inform public health interventions and antimicrobial stewardship. However, while the study has merit, several aspects require major revision before it can be considered for publication.

Comments:

Comment 1 (General comment on the manuscript): The manuscript requires extensive language editing. Numerous grammatical issues and awkward phrasing obscure key points (e.g., “big concern” should be “serious concern”). The narrative lacks clarity in places, particularly in the results and discussion sections. Consider professional English editing.

Comment-2 (Title): Better if edited like as: Antibiotic Resistance Profiles of Bacteria Isolated from Clinical Specimens at Amhara National Regional State Public Health Institute, Bahir Dar, Ethiopia: A Retrospective Study. Antibiotic resistance" replaces "antimicrobial resistance" to specifically target bacterial pathogens and Bacteria isolated from clinical specimens" improves clarity and grammatical flow.

Abstract section:

Comment 3: The abstract is overly detailed for a structured abstract, (should be within 250-300 words).

Comment 4: Consider shortening results to key findings with precise percentages for major resistant pathogens. Ensure consistent formatting of species names (e.g., Escherichia coli, Staphylococcus aureus) in italics throughout. Do not use abbreviation and also both in the abstract.

Comment 5: In line number 36: “The drug susceptibility test was performed using the Kirby-Bauer disc diffusion method on Muller-Hinton agar” who was performed the AST? Please make it clear or omit. And also use the specific term like antibiotic rather drug.

Comment 6: Reduce redundancy of information, like study period, you have mentioned in both background and methods.

Comment 7: In the results section (lines 38–62), please include only the key findings with precise percentages for major resistant bacterial pathogens, and omit the fungal findings, as your study focuses on bacteria, not all microorganisms.

Comment 8: The conclusion effectively highlights the public health implications of the findings. However, consider strengthening the impact by specifying the most concerning resistant pathogens identified in your study. This would better tie the conclusion to your results and emphasize the urgency of surveillance and stewardship efforts.

Methods and Materials section: Please follow the PLOS ONE guideline:

Comment 9: Rewrite “Material and Methods” like as Methods and Materials

Comment 10: Break specifically “Study design, period and area” and maintain consistency

Comment 11: There is a lack of detail regarding quality control measures and breakpoint interpretation standards (e.g., CLSI 2021 or 2022?). Ensure that versions are cited and methodological adherence is clear.

Comment 12: Study population (line number132-136) “….a patients who visited APHI Medical Microbiology Reference Laboratory and had complaints of any infection suspected of microbial infections during the study period”. As you know your study was retrospective so make it clear to reduce confusion with prospective aspects.

Comment 13: Consider clarifying inclusion/exclusion criteria, e.g., how incomplete records were managed and whether duplicates were removed.

Comment 14: Line number 146 “Specimen collection, processing, and bacterial identifications” since your study was retrospective, thus, it is better to elaborate more about the recorded data, the way of collection and maintaining of the quality of data rather than stating about diagnostic process.

Comment 15: Please recheck and rewrite/rephrase methods and materials section by considering your source of data (line number 118-204)

Results section:

Comment 16: The results are comprehensive but not well-structured. Tables are very large and difficult to interpret.

Comment 17: Consider focusing on the most clinically relevant pathogens (e.g., E. coli, K. pneumoniae, S. aureus) in the main text and shifting exhaustive antibiograms to supplementary material.

Comment 18: Define key terms such as "MDR" clearly within the results, and consider reporting "XDR" and "PDR" if applicable.

Discussion section:

Comment 19: The discussion is lengthy, repetitive, and lacks a clear focus on clinical and policy implications.

Comment 20: There is limited critical reflection on factors contributing to resistance in the local context (e.g., prescribing practices, diagnostics access, stewardship programs).

Comment 21: Compare findings with WHO GLASS data and other sub-Saharan Africa studies more systematically.

Ethical clearance section:

Comment 22: Ethical approval is adequately described. However, the data availability statement must align with PLOS ONE policies, simply stating "data within manuscript" may not be sufficient.

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what does this mean? ). If published, this will include your full peer review and any attached files.

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Reviewer #1: Yes:  Gebrie Kassaw Yirga

Reviewer #2: No

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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 comment ploseeone.pdf

Dear Dr. Getie,

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 Oct 09 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.

• 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,

Tebelay Dilnessa, MSc

Academic Editor

PLOS ONE

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 

Additional Editor Comments:

• The paper was improved, still it requires revision. I would like to recommend you that you have to revise it properly.
• Line 104: Materials and methods
• Lines 60 &61: It is better the author use standard form of Gram-positive or Gram-negative (previous comment).
• Lines 106 and 107: The study was conducted at APHI, Bahir Dar city. Which is 565 km away from Addis Ababa (the capital of Ethiopia) a………Please revise it, based on the context, there is no sentence that starts by using ‘Which’.
• Write separately ‘study population’ and ‘sampling technique’.
• Line 144: Bacterial isolation and identification
• Line 206: Data quality control
• I recommend a separate heading as ‘Sociodemographic characteristics of study participants’ and ‘Magnitudes of bacteria’.
• Rewrite from line 251 to 267. A sentence cannot start just by saying ‘Table 1:……’
• Line 270: What does it mean ‘Table 2’?
• In table 2, you considered ‘Candida albicans’as bacteria. Is that correct? Please make a revision.
• In the abstract and result, the absolute number (numerator and denominator) is needed together with the percentage. For example, A/B (C%) (previous comment).
• Line 311 and 326: Gram-negative
• Line 334, 346, etc: Gram-positive

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

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #3: (No Response)

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

Reviewer #3: Yes

**********

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

Reviewer #3: Yes

**********

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

The PLOS Data policy

Reviewer #3: Yes

**********

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

Reviewer #3: Yes

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Reviewer #3:  Article Review Report

Title: Antimicrobial Resistance Profiles of Bacteria from Clinical Specimens at Amhara National Regional State Public Health Institute, Bahir Dar, Ethiopia: A Retrospective Study

� longer, reduce the length for more brevity

Abstract

� Line 28: Replace "antimicrobial resistance pattern" with "antimicrobial resistance profile" for consistency with the title.

� Line 32: Specify the age range of patients included in the laboratory results

� Punctuation: Add a colon (:) after "Background" and "Methods."

� Line 31: It is generally preferred to use "July 1, 2022, to December 31, 2024" instead of "1/7/2022 to 31/12/2024.

� Line 36: If data were collected, please indicate the tools used; if the data were extracted rather than collected, please clarify that.

� Line 37: In "descriptive statistics," it would improve clarity to specify the types of analyses conducted (e.g., frequency distributions, chi-square tests).

� Line 40: add denominator for 41.4% (95% CI: 39; 44) and indicate in your mother document the section that show stool (263; 54.6%), urine (98; 20.3%), wound (62; 12.9%), blood (47; 9.8%).

� In line 42-48: if you are reporting bacteria just use the total bacterial isolates which is 478

Methods and Materials

rewrite "Methods and Material" as: Methods and Materials

Study area

� Include details about the type of culturing and the data handling and storing system to ensure consistency with WHONET,

� In line 120-21, data records of two and a half years of data from 1/7/2022 to 31/12/2024; both times operationally similar. Use one of them.

� In line 122-4, the objective is already stated under introduction, no need to repeat

� In line 131-4, ….. The study utilized an entire sampling technique that included all available microbiology culture records of patients of all age groups suspected of having microbial infections during study period. What is that entire sampling technique?

Inclusion and exclusion criteria

� In line 138, Patient seating indicates?

Bacterial identification

� In line 151, indicate the year for CLSI

Data source and access

No comment

Specimen and Data quality control

No comment

Data analysis

Include my comment from abstract section

Ethics approval

In line 125-6: This manuscript does not report on or involve the use of any animal or human data or tissue. Be sure of this?

Results

Line 260: Please remove "Table 1" from the sentence "most frequently culture-processed specimens.

Culture Results in Table 2: Refine the percentages by calculating them based on the total sample denominator. Additionally, since the title focuses on antimicrobial resistance profiles of bacteria, consider excluding Candida albicans from the analysis or modifying the title accordingly.

Please provide a rationale for any variables that were not analyzed.

Discussion

� Lines 381-382: The study reported an overall bacterial isolation frequency of 41.4% (482 isolates) from clinical specimens. However, this total includes 4 fungal isolates, which are not classified as bacterial isolates and need your action

� In line 390: Better to move this explanation after line 390 ( The most possible explanation could be due to the difference in culture identification technique in the study population, the study design, geographical location, etiological agents, and infection prevention and control policies between regions and countries [2, 13, and 24]).

� Reference at end of line 408 and 466

Reference

� Check for correctness of reference for number 4(format), 7(format and version), 24 (format) and 46 (format)

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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 #3: 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: Article Review Report.docx

Antimicrobial Resistance Profiles of Bacteria from Clinical Specimens at Amhara Public Health Institute, Bahir Dar, Ethiopia: A Retrospective Study

PONE-D-25-08930R2

Dear Dr. Getie,

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. For questions related to billing, please contact billing support .

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,

Tebelay Dilnessa, MSc

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #3: All comments have been addressed

**********

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

Reviewer #3: Yes

**********

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

Reviewer #3: Yes

**********

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

The PLOS Data policy

Reviewer #3: Yes

**********

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

Reviewer #3: Yes

**********

Reviewer #3: Dear Authors,

I appreciate your thorough attention to the comments and the subsequent corrections made. Thank you for your dedication to this research, which significantly contributes to addressing the prevalent issue of antimicrobial resistance (AMR) in Ethiopia and beyond.

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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 #3: No

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