Reviewer's report
Title:T.E.A. Study, Three days Ertapenem versus three days
Ampicillin-sulbactam
Version: 2Date:29 February 2012
Reviewer: Vitaliy Poylin
Reviewer's report:
Authors present a paper on effect of different antibiotic regiment on
peri-operative infectious complications. They should be commended for trying to
address a difficult and definitely understudied question of duration of antibiotic
regiment. I think the most significant outcome of this study is reduction is
superficial infections on Ertapenem. This studies confirms a few recent reports
from colorectal literature on use of this antibiotic and could have a significant
effect on changing peri-operative antibiotic regiment.
However, there are a few issues that need to be addressed.
Major Compulsory Revisions
1.The paper is lacking proper description of two study groups. Although severity
of their illness is assessed, extent of their surgical problem and intra-operative
findings are not, i.e. – were their abscesses pre-operatively that require drainage,
was there a phlegmon present, etc, so including CT/US and intra-operative
findings for both groups is very important for the study like this.
2. Indications for surgery for diverticulitis in both groups are not clear – current
standard of care for acute diverticulitis is medical management, and reasons for
needing to operate on these patients within 24 hours would be very important
factors to consider as far as infectious complications go.
3. Distribution of infectious complications (which disease process if any had most
superficial and deep infectious complications) is very important and not reported.
4. Other complications reported in total numbers but not details, for example,
where there any c diff infections following antibiotic treatment.
5.Surgical approach is not reported – minimally invasive surgery has well
documented lower rate of superficial infections.
Discretionary Revisions
There is also a question of duration of antibiotics – there is a body of literature
documenting no additional benefit, and even some harm, from prolonged
peri-operative antibiotics (beyond single pre-operative dose if possible, and no
more then 24 hours of antibiotics total) for routine acute and elective cases. So it
is not clear to me why patients would need 3 days of antibiotics, unless there
some other factors that were not clearly reported. A more interesting study would
be a use of single dose pre-operative antibiotic on infectious complications after
routine acute and elective abdominal surgery
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:T.E.A. Study, Three days Ertapenem versus three days
Ampicillin-sulbactam
Version: 2Date:29 February 2012
Reviewer: Vitaliy Poylin
Reviewer's report:
Authors present a paper on effect of different antibiotic regiment on
peri-operative infectious complications. They should be commended for trying to
address a difficult and definitely understudied question of duration of antibiotic
regiment. I think the most significant outcome of this study is reduction is
superficial infections on Ertapenem. This studies confirms a few recent reports
from colorectal literature on use of this antibiotic and could have a significant
effect on changing peri-operative antibiotic regiment.
However, there are a few issues that need to be addressed.
Major Compulsory Revisions
1.The paper is lacking proper description of two study groups. Although severity
of their illness is assessed, extent of their surgical problem and intra-operative
findings are not, i.e. – were their abscesses pre-operatively that require drainage,
was there a phlegmon present, etc, so including CT/US and intra-operative
findings for both groups is very important for the study like this.
2. Indications for surgery for diverticulitis in both groups are not clear – current
standard of care for acute diverticulitis is medical management, and reasons for
needing to operate on these patients within 24 hours would be very important
factors to consider as far as infectious complications go.
3. Distribution of infectious complications (which disease process if any had most
superficial and deep infectious complications) is very important and not reported.
4. Other complications reported in total numbers but not details, for example,
where there any c diff infections following antibiotic treatment.
5.Surgical approach is not reported – minimally invasive surgery has well
documented lower rate of superficial infections.
Discretionary Revisions
There is also a question of duration of antibiotics – there is a body of literature
documenting no additional benefit, and even some harm, from prolonged
peri-operative antibiotics (beyond single pre-operative dose if possible, and no
more then 24 hours of antibiotics total) for routine acute and elective cases. So it
is not clear to me why patients would need 3 days of antibiotics, unless there
some other factors that were not clearly reported. A more interesting study would
be a use of single dose pre-operative antibiotic on infectious complications after
routine acute and elective abdominal surgery
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:T.E.A. Study, Three days Ertapenem versus three days
Ampicillin-sulbactam
Version: 2Date:29 February 2012
Reviewer: Vitaliy Poylin
Reviewer's report:
Authors present a paper on effect of different antibiotic regiment on
peri-operative infectious complications. They should be commended for trying to
address a difficult and definitely understudied question of duration of antibiotic
regiment. I think the most significant outcome of this study is reduction is
superficial infections on Ertapenem. This studies confirms a few recent reports
from colorectal literature on use of this antibiotic and could have a significant
effect on changing peri-operative antibiotic regiment.
However, there are a few issues that need to be addressed.
Major Compulsory Revisions
1.The paper is lacking proper description of two study groups. Although severity
of their illness is assessed, extent of their surgical problem and intra-operative
findings are not, i.e. – were their abscesses pre-operatively that require drainage,
was there a phlegmon present, etc, so including CT/US and intra-operative
findings for both groups is very important for the study like this.
2. Indications for surgery for diverticulitis in both groups are not clear – current
standard of care for acute diverticulitis is medical management, and reasons for
needing to operate on these patients within 24 hours would be very important
factors to consider as far as infectious complications go.
3. Distribution of infectious complications (which disease process if any had most
superficial and deep infectious complications) is very important and not reported.
4. Other complications reported in total numbers but not details, for example,
where there any c diff infections following antibiotic treatment.
5.Surgical approach is not reported – minimally invasive surgery has well
documented lower rate of superficial infections.
Discretionary Revisions
There is also a question of duration of antibiotics – there is a body of literature
documenting no additional benefit, and even some harm, from prolonged
peri-operative antibiotics (beyond single pre-operative dose if possible, and no
more then 24 hours of antibiotics total) for routine acute and elective cases. So it
is not clear to me why patients would need 3 days of antibiotics, unless there
some other factors that were not clearly reported. A more interesting study would
be a use of single dose pre-operative antibiotic on infectious complications after
routine acute and elective abdominal surgery
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
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