Peer Review Report For: The antimicrobial activity of EDTA in combination with Meropenem, Amikacin, and Piperacillin-Tazobactam against hospital-multidrug-resistant Escherichia coli and Klebsiella pneumoniae isolates [version 2; peer review: 1 approved with reservations, 1 not approved]

The escalating global threat of antimicrobial resistance presents a critical challenge to public health. In Iraq, the increasing rise of resistance strains further confirms the need for innovative treatment strategies. Ethylenediaminetetraacetic acid (EDTA) has shown promise in enhancing antibiotic efficacy via destabilizing bacterial membranes and disrupting biofilms. Objectives This study examines the effects of combining EDTA with commonly used antibiotics on multidrug-resistant Escherichia coli and Klebsiella pneumoniae isolates from a major hospital in Baghdad, Iraq. Additionally, it assesses the prevalence of antibiotic resistance in these bacterial strains. The main goal is to improve treatment outcomes and address the growing challenges of antimicrobial resistance in healthcare settings. Methods This experimental in vitro study evaluates the effects of combining EDTA with meropenem, amikacin, and piperacillin-tazobactam on multidrug-resistant Escherichia coli and Klebsiella pneumoniae isolates from clinical samples. Results The results show that EDTA enhanced the antibiotics’ effectiveness, increasing inhibition zone diameters and improving bacterial susceptibility. The inhibition zone expanded by approximately 2 to 5 millimeters. Resistance patterns shifted, with some previously resistant or intermediate strains becoming susceptible when treated with the combined therapy. In conclusion, EDTA increases the efficacy of meropenem, amikacin, and piperacillin/tazobactam against multidrug-resistant Escherichia coli and Klebsiella pneumoniae strains. Conclusion This presents a promising approach to improve treatment options for infections caused by resistant pathogens. Further research is needed to understand EDTA’s mechanisms and clinical applications .