Impact of introducing fluorescent microscopy on hospital tuberculosis control: A before-after study at a high caseload medical center in Taiwan

Hsin-Yun Sun; Jann-Yuan Wang; Yee-Chun Chen; Po-Ren Hsueh; Yi-Hsuan Chen; Yu-Chung Chuang; Chi-Tai Fang; Shan-Chwen Chang; Jung-Der Wang

doi:10.1371/journal.pone.0230067

Peer Review History

Original SubmissionNovember 24, 2019
27 Jan 2020 Decision Letter - Frederick Quinn, Editor PONE-D-19-32578 Impact of introducing fluorescent microscopy on hospital tuberculosis control: a before-after study at a high caseload medical center in Taiwan PLOS ONE Dear Dr. Fang, 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. We would appreciate receiving your revised manuscript. When you are 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. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. 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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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 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 ****** 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 ****** 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: This manuscript had described the introduction of a novel fluorescent microscopy methodology in the diagnosis of TB. Globally, TB is still a major concern in public health, thus this manuscript contains importance and significance for clinicians. My suggestion is minor revision, with my comments as follows. Firstly, the authors had mentioned the moderate to high case load several times in this manuscript, and I reckon the high cases in this manuscript is one remarkable highlight which would be more convincing and supportive. However, what is the definition of the moderate to high, or high case load in regards with TB? Secondly, despite the large number of cases involved, this study had been performed in the Medical Center A as a single center study. Please provide some information about the routine/conventional diagnosis of TB in other medical settings and how this introduction of fluorescent microscopy methodology would improve or make difference in other hospitals in Taiwan. Thirdly, the writing could be benefit from language editing. For example, a lot of the sentences begin with subjective tense like “we…”. Some description could be more concise, for example, the approval of ethics could be combined as one sentence. Also, “we provide the data… showing that introducing… helps to…” would be a little bit too oral, “was parallel to the decrease” should be “in parallel”. Reviewer #2: I found this manuscript to be relevant, sound and well-written, apart from a few instances e.g. (a) Paragraph 2 of the "Introduction" section, Page 3; Remove "Fluorescence microscopy is a more sensitive test to diagnose pulmonary TB than conventional microscopy [16]" as it is a repetition; it is mentioned in the aforementioned sentences. (b) Still in the same section as above, the last sentence in the paragraph i.e. "Nevertheless, the effect of introducing these more sensitive diagnostic tools on risk of nosocomial TB transmission has not been studied" may not be entirely accurate as you claim. Perhaps in high-income countries with a low burden of TB (e.g. Taiwan). I suggest you revisit this. (c) 1st paragraph on page 5, Methods section; 'strain' appears to be a typo. Did you mean 'stain'? i.e. "---already received a confirmed diagnosis of pulmonary TB by a positive sputum culture of Mycobacterium tuberculosis, positive acid-fast strain (AFS),---" should be "---already received a confirmed diagnosis of pulmonary TB by a positive sputum culture of Mycobacterium tuberculosis, positive acid-fast stain (AFS),---" ****** 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. 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Revision 1
12 Feb 2020 Author Response Dear Prof. Quinn, Thank you for your encouraging response to our work. We greatly appreciate the reviewers’ constructive comments. We have endeavored to incorporate the feedback and revised our manuscript accordingly, with alterations highlighted in red color. Responses to each point of the reviewer’s comments were listed below. Thank you again for your kind consideration and look forward to hearing from you soon. Sincerely yours, Chi-Tai Fang, MD, PhD Professor Division of Infectious Diseases National Taiwan University Hospital 7 Chun-Shan South Road., Taipei 100, Taiwan. Phone: +886 2 3366-8035 E-mail: fangct@ntu.edu.tw To Reviewer 1: Thank you for your positive response to our work and the kind advice. We greatly appreciate your constructive comments that have helped us improve our paper. We have endeavored to incorporate the feedback and revised our manuscript accordingly. The itemized response (abbreviated as R) are as follows: C1. Firstly, the authors had mentioned the moderate to high case load several times in this manuscript, and I reckon the high cases in this manuscript is one remarkable highlight which would be more convincing and supportive. However, what is the definition of the moderate to high, or high case load in regards with TB? R1. There are approximately 400 culture-confirmed TB cases annually in medical center A (ll. 33-34, 94 and 172), which has the second-highest caseload in Taiwan. We admit that we did not have a definition for “moderate to high” or “high” case load. For consistency, we revised all “moderate-to-high” to “high”. (ll. 30, 45, 62, 223, 337) C2. Secondly, despite the large number of cases involved, this study had been performed in the Medical Center A as a single center study. Please provide some information about the routine/conventional diagnosis of TB in other medical settings and how this introduction of fluorescent microscopy methodology would improve or make difference in other hospitals in Taiwan. R2. We added a paragraph in Discussion section to address these important issues: “Currently, most hospitals in Taiwan still used traditional Ziehl-Neelsen staining (or Kinyoun staining, a similar method) and conventional light microscopy in laboratory diagnosis of TB. An analysis of 2003-2010 Taiwan National Health Insurance database revealed that frequent exposure to hospital environment is a risk factor for contracting TB in Taiwan (adjusted odds ratio: 1.77, for those with ≥ 30 outpatient care visit annually) [31]. Our findings on the impact of switching to auramine-rhodamine staining with fluorescence microscopy suggest that a nationwide adoption and roll-out might cut the risk of nosocomial TB transmission to both patients and healthcare workers.” (ll. 301-308) C3. Thirdly, the writing could be benefit from language editing. For example, a lot of the sentences begin with subjective tense like “we…”. Some description could be more concise, for example, the approval of ethics could be combined as one sentence. Also, “we provide the data… showing that introducing… helps to…” would be a little bit too oral, “was parallel to the decrease” should be “in parallel”. R3. The manuscript has been edited to avoid repetitive use of sentence begin with subjective tense “We…”. The following sentences were also revised as recommended: “The study procedure and exemption of informed consent were reviewed and approved by Research Ethics Committee of National Taiwan University Hospital (Taipei, Taiwan).” (ll. 114-115) “Our study showed that introducing highly sensitive rapid diagnostic tools decreases the risk of nosocomial TB transmission from hospitalized patients with undiagnosed TB in a high TB risk setting.” (ll. 222-224) “the decrease in time-to-isolation and total non-isolated infectious patient-days was in parallel in the present study.” (ll. 233-234) To Reviewer #2: Thank you for your positive response to our work and the kind advice. We greatly appreciate your constructive comments that have helped us improve our paper. We have endeavored to incorporate the feedback and revised our manuscript accordingly. The itemized response (abbreviated as R) are as follows: C1. I found this manuscript to be relevant, sound and well-written, apart from a few instances e.g. (a) Paragraph 2 of the "Introduction" section, Page 3; Remove "Fluorescence microscopy is a more sensitive test to diagnose pulmonary TB than conventional microscopy [16]" as it is a repetition; it is mentioned in the aforementioned sentences. R1. We thank the reviewer for the kind comments and deleted the repetitive sentence as suggested. C2. (b) Still in the same section as above, the last sentence in the paragraph i.e. "Nevertheless, the effect of introducing these more sensitive diagnostic tools on risk of nosocomial TB transmission has not been studied" may not be entirely accurate as you claim. Perhaps in high-income countries with a low burden of TB (e.g. Taiwan). I suggest you revisit this. R2. We searched PubMed but did not find any published study which assessed the effect of introducing more sensitive diagnostic tools on risk of nosocomial TB transmission in either high-income or low-income countries. However, we cannot exclude the possibility that such assessment may have been performed but not published in academic journals. We therefore revised the sentences as below: “to our knowledge, the effect of introducing these more sensitive diagnostic tools on reducing risk of nosocomial TB transmission has not been documented.” (II. 72-74) C3. (c) 1st paragraph on page 5, Methods section; 'strain' appears to be a typo. Did you mean 'stain'? i.e. "---already received a confirmed diagnosis of pulmonary TB by a positive sputum culture of Mycobacterium tuberculosis, positive acid-fast strain (AFS),---" R3. We apologize for the typo. The correct spelling should be: “positive acid-fast stain (AFS)” (ll. 129) https://doi.org/10.1371/journal.pone.0230067.r002
21 Feb 2020 Decision Letter - Frederick Quinn, Editor Impact of introducing fluorescent microscopy on hospital tuberculosis control: a before-after study at a high caseload medical center in Taiwan PONE-D-19-32578R1 Dear Dr. Fang, We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements. Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication. Shortly after the formal acceptance letter is sent, an invoice for payment will follow. 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With kind regards, Frederick Quinn 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 #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 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: Yes 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 Response) ****** 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: Authors have satisfactorily addressed all the comments. I recommend that the revised manuscript be published. ****** 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: Yes: Zhenbo Xu Reviewer #2: Yes: David Patrick Kateete https://doi.org/10.1371/journal.pone.0230067.r003
Formally Accepted
23 Mar 2020 Acceptance Letter - Frederick Quinn, Editor PONE-D-19-32578R1 Impact of introducing fluorescent microscopy on hospital tuberculosis control: a before-after study at a high caseload medical center in Taiwan Dear Dr. Fang: I am pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please notify them about your upcoming paper at this point, to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, please inform our press team within the next 48 hours. 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. For any other questions or concerns, please email plosone@plos.org. Thank you for submitting your work to PLOS ONE. With kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Frederick Quinn Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0230067.r004

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