Urinary Tract Infections and Drug Resistance Patterns in Heart Failure Patients on Sodium-Glucose Transporter 2 Inhibitors: Evidence from Jakaya Kikwete Cardiac Institute in Tanzania

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: No

Reviewer #2: Partly

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

Reviewer #1: No

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: No

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 title needs to be changed to capture the risk factors that have extensively been discussed in the study. The author also needs to go through the article attached as it has additional comments on how to make the manuscript better.

Reviewer #2: Title

The title is clear, well structured, and easy to understand.

Abstract

• Replace “midstream urine samples” with midstream clean catch urine samples throughout the text whenever applicable.

• Use the correct term for urine culture semi-quantitative urine culture, consistently.

• Revise the sentence: “Out of 138 participants among those cultured”—this is misleading, as patients themselves are not cultured; rather, their biological samples (e.g., urine) are cultured.

• Ensure all percentages are reported with one decimal place (e.g., 50.0%).

• In the conclusion, specify the study population to emphasize clinical application, e.g., “… routine urine culture and sensitivity testing among (HF patients on SGLT2 inhibitors) to guide appropriate therapy …”.

Background

• Support the second paragraph with proportions or prevalence rates of UTI in HF patients on SGLT2 inhibitors compared to those not on SGLT2 inhibitors, including contradictory findings. This will strengthen the justification for the current study.

Methods

• Study population: delete the repeated word “receiving.”

• Sample size estimation: provide a citation for the reference used in sample size calculation.

• Clearly state whether the urine collection containers were sterile.

• Laboratory analysis: revise the subheading, as the words “culture” and “isolation” convey the same concept.

• Delete repeated wording in: “The urine sample was inoculated (at the microbiology laboratory) using a calibrated 1 microliter disposable loop in a cysteine, lactose electrolyte-deficient (CLED) agar, and blood agar media”, since the laboratory has already been mentioned earlier.

• Define “significant growth” in the sentence: “After 24 hours of incubation at 35–37 °C, significant growth (≥105 CFU/ml) was further analyzed.”

• Delete “isolated” from: “… and specific bacteria were (isolated) and identified through colony morphology, gram reaction, and biochemical tests.”

• Report bacterial growth using SI units: >10⁴ CFU/ml.

• In case of pure growth with bacterial quantity of ≥104 CFU/ml, what was the way forward?

• Revise: “Bacterial isolation and identification were conducted using standard culture and biochemical tests” by briefly describing the tests used for Gram-negative and Gram-positive bacteria, and citing an appropriate reference.

• Revise: “Urinalysis preceded urine culture on CLED and blood agar, with uropathogens identified by colony morphology and biochemical tests” to clearly describe the urinalysis procedure/test performed e.g., microscopy or dipstick. Additionally, respective results should be provided in the Results sections and discussed in the Discussion section.

• Cite an appropriate reference for the Kirby Bauer disk diffusion method.

• Antimicrobial susceptibility testing: delete the word “one,” which may be misleading for organisms with small colony size such as Enterococcus spp or Streptococcus spp.

• Include brand, city, and country of manufacturer for all culture media and antimicrobial discs.

• Provide the abbreviation for Penicillin G.

Results

• Begin the section on sociodemographic and clinical characteristics with the total number of participants enrolled.

• Prevalence of UTI and risk factors: do not start sentences with numerals. Clarify why 138 urine samples were processed out of 141 patients. The 3 missing samples, whether not submitted to the lab or rejected by the lab, should be excluded from analysis.

• Uropathogens identified: do not italicize “spp” or “species” (see: Candida spp (9.1%)).

• State the total number of uropathogens identified from the 138 urine cultures. Clarify whether any samples yielded 2 significant organisms (≥10⁵ CFU/ml), resulting in >138 isolates.

• Provide actual counts in the prevalence statement, e.g., Escherichia coli (50.0%; n=69) or (50.0%; 69/138).

• Table 4: define “(TM)” in the footnotes and arrange all abbreviations and their definitions in alphabetical order.

Discussion

• In the first paragraph, include prevalence estimates reported in relevant meta-analyses, with citations.

• Correct all typographical errors, such as missing full stops or spaces between sentences (see first paragraph).

• The following sentence is not clear: “The observed late occurrence of UTI events of up to three months can be explained by initial polyuria caused by the SGLT2 inhibitors …”. Clarify whether polyuria decreases after three months of using SGLT2, and whether glucose levels during initial polyuria (first 3 months following the use of SGLT2) are insufficient for microbial colonization and proliferation.

• Explain the clinical implications of your findings for the management of HF patients on SGLT2.

• Add a Study limitations section following the Discussion and before the Conclusion.

References

• Cite the appropriate CLSI as suggested on their guidelines page no. ii (Suggested citation).

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: JKCI study.pdf

Dear Dr. Mutagonda,

1. Antimicrobial Susceptibility Testing in the Method section. Revisit this section-->-->2. The Result section: You attempted to correct some errors here but not all-->-->3. The Discussion section. You skipped some of the corrections here

Please submit your revised manuscript by Feb 11 2026 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.. 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 letter that responds to each point raised by the academic editor and reviewer 1. 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'.

Kind regards,

Tombari Pius Monsi, Ph.D

Academic Editor

PLOS One

Urinary tract infections, Risk factors and antimicrobial Resistance Patterns in Heart Failure patients on Sodium-Glucose Transporter 2 Inhibitors: Evidence from Jakaya Kikwete Cardiac Institute in Tanzania

PONE-D-25-48414R2

Dear Dr. Mutagonda,

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,

Tombari Pius Monsi, Ph.D

Academic Editor

PLOS One