Reviewer’s report
Title: Fecal carriage of multidrug-resistant Escherichia coli by community children in Southern Taiwan
Version: 0 Date: 14 Dec 2016
Reviewer: Jan Egil Afset
Reviewer's report:
In this study the authors present data on susceptibility and genotype of E. coli collected from stool
samples of children in southern Taiwan. They also present a literature review on published papers on
the same topic.
Major comments
The paper includes a comparatively low number of children, which do not necessarily represent all
children outside hospital children, and neither does the fact that these children were admitted to
hospital. Lack of information about cause of admission/ clinical condition makes consideration of their
representativeness even more difficult. The definition of multidrug resistance (from reference 14) used
in the study does not seem to match the international agreed definition (EUCAST, CLSI and FDA)
(Magiorakos et al. 2012;18:268-281). Finally, the results presented includes both the authors´own data
and a literature review, which is an unusual combination of presenting data. In a literature review I
would expect a more stringent description of the methods section. I also think that the authors may tend
to over-interpret the correlation between ESBL prevalence and GNP presented in figure 3- they have
only 8 data points, which are not linearly distributed in the graph. To what extent may methods used in
the different studies influence on results? For this manuscript I would suggest it would be better to
include the data from the other published paper either as part of the introduction or the Discussion
section, rather than as a literature review.
Minor comments
Page 4, line 65: what is meant by "finely tuned"
P 5, L81: use of "the"  "…investigated the fecal carriage of MDR.." and generally use of "the" in the
text: I suggest the authors get a person with English as first language to read through the manuscript.
P5, L92: why was not information on cause of admission collected. This would have been useful for
estimation to what degree these children could represent community children.
P7, L115-120: as far as I can see this definition of MDR used in this paper does not comply with the
unified definition for USA and Europe published in 2012 (see above). This will make comparison of
results difficult.
P8, L135: what is meant by "suitable articles". It would be preferable if you could be more specific.
P8, L 141-142: why did you want to compare prevalence of ESBL and GDP? I would like to see the
hypothesis/ argumentation behind doing this type of analysis. 
P12, L214-219: I don´t understand what you try to explain here. Could you reformulate?
P12, L223-224: This statement should be followed a reference.
P13, L 229-230: I don´t understand that you can conclude that lack of risk factors indicated that the
UTIs were mostly community and not hospital acquired. Can you argue better for this conclusion?
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
Are you able to assess any statistics in the manuscript or would you recommend an additional 
statistical review?
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose financially 
from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds or 
has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below. If 
your reply is yes to any, please give details below.
I declare that I have no competing interests
I agree to the open peer review policy of the journal. I understand that my name will be included on my
report to the authors and, if the manuscript is accepted for publication, my named report including any 
attachments I upload will be posted on the website along with the authors' responses. I agree for my 
report to be made available under an Open Access Creative Commons CC-BY license 
(http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments which I do not wish to 
be included in my named report can be included as confidential comments to the editors, which will not
be published.
I agree to the open peer review policy of the journal
Reviewer’s report
Title: Fecal carriage of multidrug-resistant Escherichia coli by community children in Southern Taiwan
Version: 0 Date: 14 Dec 2016
Reviewer: Jan Egil Afset
Reviewer's report:
In this study the authors present data on susceptibility and genotype of E. coli collected from stool
samples of children in southern Taiwan. They also present a literature review on published papers on
the same topic.
Major comments
The paper includes a comparatively low number of children, which do not necessarily represent all
children outside hospital children, and neither does the fact that these children were admitted to
hospital. Lack of information about cause of admission/ clinical condition makes consideration of their
representativeness even more difficult. The definition of multidrug resistance (from reference 14) used
in the study does not seem to match the international agreed definition (EUCAST, CLSI and FDA)
(Magiorakos et al. 2012;18:268-281). Finally, the results presented includes both the authors´own data
and a literature review, which is an unusual combination of presenting data. In a literature review I
would expect a more stringent description of the methods section. I also think that the authors may tend
to over-interpret the correlation between ESBL prevalence and GNP presented in figure 3- they have
only 8 data points, which are not linearly distributed in the graph. To what extent may methods used in
the different studies influence on results? For this manuscript I would suggest it would be better to
include the data from the other published paper either as part of the introduction or the Discussion
section, rather than as a literature review.
Minor comments
Page 4, line 65: what is meant by "finely tuned"
P 5, L81: use of "the"  "…investigated the fecal carriage of MDR.." and generally use of "the" in the
text: I suggest the authors get a person with English as first language to read through the manuscript.
P5, L92: why was not information on cause of admission collected. This would have been useful for
estimation to what degree these children could represent community children.
P7, L115-120: as far as I can see this definition of MDR used in this paper does not comply with the
unified definition for USA and Europe published in 2012 (see above). This will make comparison of
results difficult.
P8, L135: what is meant by "suitable articles". It would be preferable if you could be more specific.
P8, L 141-142: why did you want to compare prevalence of ESBL and GDP? I would like to see the
hypothesis/ argumentation behind doing this type of analysis. 
P12, L214-219: I don´t understand what you try to explain here. Could you reformulate?
P12, L223-224: This statement should be followed a reference.
P13, L 229-230: I don´t understand that you can conclude that lack of risk factors indicated that the
UTIs were mostly community and not hospital acquired. Can you argue better for this conclusion?
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
Are you able to assess any statistics in the manuscript or would you recommend an additional 
statistical review?
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose financially 
from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds or 
has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below. If 
your reply is yes to any, please give details below.
I declare that I have no competing interests
I agree to the open peer review policy of the journal. I understand that my name will be included on my
report to the authors and, if the manuscript is accepted for publication, my named report including any 
attachments I upload will be posted on the website along with the authors' responses. I agree for my 
report to be made available under an Open Access Creative Commons CC-BY license 
(http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments which I do not wish to 
be included in my named report can be included as confidential comments to the editors, which will not
be published.
I agree to the open peer review policy of the journal
Please review this paper.
user
Reviewer’s report
Title: Fecal carriage of multidrug-resistant Escherichia coli by community children in Southern Taiwan
Version: 0 Date: 14 Dec 2016
Reviewer: Jan Egil Afset
Reviewer's report:
In this study the authors present data on susceptibility and genotype of E. coli collected from stool
samples of children in southern Taiwan. They also present a literature review on published papers on
the same topic.
Major comments
The paper includes a comparatively low number of children, which do not necessarily represent all
children outside hospital children, and neither does the fact that these children were admitted to
hospital. Lack of information about cause of admission/ clinical condition makes consideration of their
representativeness even more difficult. The definition of multidrug resistance (from reference 14) used
in the study does not seem to match the international agreed definition (EUCAST, CLSI and FDA)
(Magiorakos et al. 2012;18:268-281). Finally, the results presented includes both the authors´own data
and a literature review, which is an unusual combination of presenting data. In a literature review I
would expect a more stringent description of the methods section. I also think that the authors may tend
to over-interpret the correlation between ESBL prevalence and GNP presented in figure 3- they have
only 8 data points, which are not linearly distributed in the graph. To what extent may methods used in
the different studies influence on results? For this manuscript I would suggest it would be better to
include the data from the other published paper either as part of the introduction or the Discussion
section, rather than as a literature review.
Minor comments
Page 4, line 65: what is meant by "finely tuned"
P 5, L81: use of "the"  "…investigated the fecal carriage of MDR.." and generally use of "the" in the
text: I suggest the authors get a person with English as first language to read through the manuscript.
P5, L92: why was not information on cause of admission collected. This would have been useful for
estimation to what degree these children could represent community children.
P7, L115-120: as far as I can see this definition of MDR used in this paper does not comply with the
unified definition for USA and Europe published in 2012 (see above). This will make comparison of
results difficult.
P8, L135: what is meant by "suitable articles". It would be preferable if you could be more specific.
P8, L 141-142: why did you want to compare prevalence of ESBL and GDP? I would like to see the
hypothesis/ argumentation behind doing this type of analysis. 
P12, L214-219: I don´t understand what you try to explain here. Could you reformulate?
P12, L223-224: This statement should be followed a reference.
P13, L 229-230: I don´t understand that you can conclude that lack of risk factors indicated that the
UTIs were mostly community and not hospital acquired. Can you argue better for this conclusion?
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
Are you able to assess any statistics in the manuscript or would you recommend an additional 
statistical review?
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose financially 
from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds or 
has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below. If 
your reply is yes to any, please give details below.
I declare that I have no competing interests
I agree to the open peer review policy of the journal. I understand that my name will be included on my
report to the authors and, if the manuscript is accepted for publication, my named report including any 
attachments I upload will be posted on the website along with the authors' responses. I agree for my 
report to be made available under an Open Access Creative Commons CC-BY license 
(http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments which I do not wish to 
be included in my named report can be included as confidential comments to the editors, which will not
be published.
I agree to the open peer review policy of the journal
assistant