{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T09:48:49Z","timestamp":1791798529727,"version":"4.3.4"},"update-to":[{"DOI":"10.12688\/f1000research.162892.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T00:00:00Z","timestamp":1763164800000}}],"reference-count":33,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T00:00:00Z","timestamp":1763164800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns5:p>Background Head and neck cancer (HNCs) is a major health issue worldwide, and India has contributed to approximately 2.4 lakh new cases in 2022. Definitive chemoradiation is the standard treatment for locally advanced disease but carries a risk of lower respiratory tract infections (LRTI) that add to morbidity, hospitalization, cost, and possible delay in treatment. The increasing incidence of antimicrobial resistance (AMR) has also contributed to management burden. This study aimed to assess the microbiological profiles and antimicrobial resistance patterns of lower respiratory tract infections in patients with head and neck cancer receiving chemoradiation. Methods Patients who underwent definitive radiotherapy with or without chemotherapy and who developed LRTIs were included in the study. Sputum and tracheostomy suction tip cultures were obtained and processed using standard microbiological techniques such as Gram staining, biochemical tests, and VITEK-2 automated systems. Antimicrobial susceptibility was tested according to the Clinical and Laboratory Standards Institute (CLSI) and EUCAST recommendations. Clinical and treatment-related factors were documented and compared using SPSS version 23.0, with descriptive statistics, chi-square tests, t-tests, ANOVA, and logistic regression models. Results Pseudomonas aeruginosa was the most frequently isolated pathogen (35.0%), followed by Klebsiella pneumoniae (16.7%), and Acinetobacter baumannii (10.0%). The pathogens were strongly resistant to fluoroquinolones and third-generation cephalosporins but were susceptible to carbapenems and aminoglycosides in the majority of isolates. Pseudomonas aeruginosa was the most frequent pathogen in all age groups and chemotherapy regimens (p&lt;0.001). Conclusion LRTIs in patients with HNC treated with chemoradiation were mainly caused by multidrug-resistant Pseudomonas aeruginosa and Klebsiella pneumoniae. Resistance patterns are crucial for directing empirical antibiotic therapy, minimizing treatment delays, and enhancing clinical outcomes.<\/ns5:p>","DOI":"10.12688\/f1000research.162892.2","type":"journal-article","created":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T12:55:05Z","timestamp":1763211305000},"page":"314","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Spectrum of lower respiratory tract infections and antimicrobial resistance pattern in head and neck cancer patients undergoing chemoradiation"],"prefix":"10.12688","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5843-0239","authenticated-orcid":false,"given":"Ashima","family":"Palia","sequence":"first","affiliation":[{"name":"Kasturba Medical College Mangalore Karnataka Manipal 576 104 Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaishnavi","family":"Singh","sequence":"additional","affiliation":[{"name":"Kasturba Medical College Mangalore Karnataka Manipal 576 104 Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1425-0097","authenticated-orcid":false,"given":"Suchitra","family":"Shenoy","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Kasturba Medical College Mangalore Karnataka Manipal 576 104 Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prerana","family":"Baruah","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kasturba Medical College Mangalore Karnataka Manipal 576 104 Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pooja","family":"Prakash","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kasturba Medical College Mangalore Karnataka Manipal 576 104 Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4691-9728","authenticated-orcid":false,"given":"Athiyamaan","family":"MS","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kasturba Medical College Mangalore Karnataka Manipal 576 104 Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sourjya","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kasturba Medical College Mangalore Karnataka Manipal 576 104 Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Sunny","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kasturba Medical College Mangalore Karnataka Manipal 576 104 Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Simon","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kasturba Medical College Mangalore Karnataka Manipal 576 104 Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Challapalli","family":"Srinivas","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kasturba Medical College Mangalore Karnataka Manipal 576 104 Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9222-863X","authenticated-orcid":false,"given":"Dilson","family":"Lobo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kasturba Medical College Mangalore Karnataka Manipal 576 104 Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamtha","family":"Suvarna","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kasturba Medical College Mangalore Karnataka Manipal 576 104 Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9318-7024","authenticated-orcid":false,"given":"Abhishek","family":"Krishna","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kasturba Medical College Mangalore Karnataka Manipal 576 104 Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2025,11,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"229-263","DOI":"10.3322\/CAAC.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.","volume":"74","author":"F Bray","journal-title":"CA Cancer J. 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Is the work clearly and accurately presented and does it cite the current literature? &nbsp;&nbsp; Partly &nbsp;&nbsp; - Strengths: The introduction contextualizes the burden of HNC in India and highlights the clinical significance of LRTIs in chemoradiation patients. References to AMR trends in cancer patients are relevant. &nbsp;&nbsp; - Criticisms:&nbsp; The introduction does not cite recent studies (post-2020) on AMR patterns in HNC patients, particularly in Indian cohorts.&nbsp; Comparisons to similar studies would strengthen the rationale.  \n<b>Authors Reply: <\/b>We acknowledge the need to incorporate recent studies on antimicrobial resistance (AMR) patterns in head and neck cancer patients, particularly from Indian cohorts. We will revise the introduction to include relevant post-2020 studies comparing our findings with similar research in the revised manuscript.  2. Is the study design appropriate and is the work technically sound? &nbsp;&nbsp; Partly &nbsp;&nbsp; - Strengths: The design in this sudy is suitable for evaluating microbiological profiles. Standard microbiological methods (Gram staining, VITEK-2) and CLSI\/EUCAST guidelines ensure technical validity. &nbsp;&nbsp; - Criticisms:&nbsp; The study does not clarify how sputum samples were validated for quality to exclude oral flora contamination. Comorbidities (e.g., diabetes, COPD) and prior antibiotic use (a critical driver of AMR) are not analyzed as covariates in the logistic regression model.  \n<b>Authors Reply: <\/b>To ensure sample quality, we validated sputum samples using Gram stain criteria, including only those with &lt;10 epithelial cells and &gt;25 polymorphonuclear leukocytes per low-power field. We will &nbsp;mention this in the methodology section for clarity. Regarding prior antibiotic use, we included only patients whose sputum samples were collected before initiating antibiotic therapy. This ensures that our bacterial isolates and resistance patterns were not influenced by prior treatment. As our study specifically focused on head and neck cancer patients undergoing chemoradiation, we did not analyze the correlation between comorbidities and lower respiratory tract infections (LRTI). However, we acknowledge the importance of this aspect and will clarify this limitation in the discussion section.   3. Are sufficient details of methods and analysis provided to allow replication by others? &nbsp;&nbsp; Partly &nbsp;&nbsp; - Strengths: The microbiological protocols (culture, biochemical tests, VITEK-2) and statistical tests are described. &nbsp;&nbsp; - Criticisms:&nbsp; The criteria for diagnosing LRTIs (e.g., clinical vs. radiological vs. microbiological confirmation) are not explicitly defined.  \n<b>Authors Reply:<\/b> We acknowledge the need to clearly define the criteria for diagnosing lower respiratory tract infections (LRTIs). In our study, LRTIs were diagnosed based on a combination of clinical, radiological, and microbiological criteria: Clinical Criteria: Presence of symptoms such as fever, cough with expectoration, dyspnea, and increased respiratory rate. Radiological Criteria: Chest X-ray or CT scan findings suggestive of pneumonia or bronchopulmonary infection. Microbiological Criteria: Positive sputum cultures with significant bacterial growth from validated sputum samples. We will &nbsp;include these diagnostic criteria in the methodology section for clarity in the revised manuscript\n<b>.<\/b>  Is the work clearly and accurately presented and does it cite the current literature? Partly \n<b>Authors Reply: <\/b>We will include a few more recent references in the introduction part as said above in the revised manuscript.","URL":"https:\/\/f1000research.com\/articles\/14-314\/v2#referee-comment-13692","order":1,"name":"referee-comment-13692","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Abhishek Krishna<\/b>; \n<i>Posted: 04 Sep 2025<\/i>; Dear Sir, We have shared our comments few month back.","URL":"https:\/\/f1000research.com\/articles\/14-314\/v2#referee-comment-14498","order":2,"name":"referee-comment-14498","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.190184.r497731, Lanisha Sequeira, Father Muller Medical College, Mangalore, Karnataka, 02 Jul 2026, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/14-314\/v2#referee-response-497731","order":3,"name":"referee-response-497731","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.190184.r497728, Saurabha Kumar, Narayana Health City, Bangalore, Karnataka, 11 Jul 2026, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/14-314\/v2#referee-response-497728","order":4,"name":"referee-response-497728","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":5,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}