Stepwise model to differentiate pathogenic from non-pathogenic organisms in urinary isolates - Effectiveness, safety, and feasibility prospective study

Sep 29, 2026

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Clinical decision-making in urinary tract infections relies on accurately distinguishing pathogenic from non-pathogenic organisms, yet no definitive method reliably determines whether a urinary isolate is truly pathogenic. This prospective, longitudinal exploratory study applied a structured stepwise model to assess urinary isolates over 24 months at AIIMS Rishikesh, using REDCap for data capture and SPSS for analysis. Among 275 adult culture-positive patients, 90.54% were classified as pathogenic and 9.45% as non-pathogenic, showing safety and feasibility.

LanguageEnglish

CategoryHealthcare

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Pages12

Reading Time30 min

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| W | J | E | M | World Journal of
Experimental Medicine | | --- | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Exp Med 2025 December 20; 15(4): 109134 DOI: 10.5493/wjem.v15.i4.109134 ISSN 2220-315x (online) ORIGINAL ARTICLE Prospective Study Stepwise model to differentiate pathogenic from non-pathogenic organisms in urinary isolates: Effectiveness, safety, and feasibility prospective study Bimalesh Yadav, Jaideep Pilania, Ravi Kant, Balram Ji Omar, Sandeep Saini, Vikas Kumar Panwar, Yogesh Bahurupi, Prasan Kumar Panda Specialty type: Medicine, research and experimental Provenance and peer review: Invited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s classification Scientific Quality: Grade B, Grade B Novelty: Grade B, Grade B Creativity or Innovation: Grade B, Grade B Scientific Significance: Grade B, Grade B P-Reviewer: Uddin MR, Researcher, Senior Researcher, Bangladesh Received: April 30, 2025 Revised: June 9, 2025 Accepted: October 15, 2025 Published online: December 20, 2025 Processing time: 233 Days and 18.3 Hours Bimalesh Yadav, Jaideep Pilania, Ravi Kant, Prasan Kumar Panda, Department of Medicine, All India Institute of Medical Sciences, Rishikesh 249203, Uttarākhand, India Balram Ji Omar, Department of Microbiology, All India Institute of Medical Sciences, Rishikesh 249203, Uttarākhand, India Sandeep Saini, Department of Nephrology, All India Institute of Medical Sciences, Rishikesh 249203, Uttarākhand, India Vikas Kumar Panwar, Department of Urology, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India Yogesh Bahurupi, Department of Community Medicine, All India Institute of Medical Sciences, Nagpur 441108, Mahārāshtra, India Corresponding author: Prasan Kumar Panda, Professor, Department of Internal Medicine, All India Institute of Medical Sciences, Room No. 409, College Block, Rishikesh 249203, Uttarākhand, [India.](India. motherprasanna@rediffmail.com)[ motherprasanna@rediffmail.com](India. motherprasanna@rediffmail.com) Abstract BACKGROUND Clinical decision-making in urinary tract infections depends heavily on accurately distinguishing between pathogenic and non-pathogenic organisms. The interpretation of urine culture results is influenced by proper sample collection, the patient's clinical context, and organism-specific characteristics. However, thereis currently no definitive method to determine whether a urinary isolate is truly pathogenic. This distinction is critical, as treatment decisions hinge on it. This pioneering study systematically applies a stepwise model to differentiate pathogenic from non-pathogenic urinary isolates—an approach not previously described. AIM To determine whether a urinary isolate is pathogenic (commensal, colonizer, or direct pathogen) or non-pathogenic (commensal, colonizer, or contaminant) using a structured, stepwise approach. WJEM [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 20, 2025 Volume 15 Issue 4 Yadav B et al. Models for differentiating microorganisms in urine fractions METHODS This prospective, longitudinal, exploratory study was conducted over 24 months, starting in January 2022, at All India Institute of Medical Sciences Rishikesh, following approval from the Institutional Ethics Committee. A stepwise model developed by the investigators was applied to assess the nature of the isolates. Data recorded using REDCap, and analysis was performed using SPSS Version 25. RESULTS A total of 275 consecutive patients aged over 18 years with positive urine cultures—initially treated with antibiotics based on microbiological and clinical assessment—were included. The stepwise model classified 90.54% of cases as pathogenic (commensals: 61.81%, colonizers: 14.18%, and direct pathogens: 14.54%) and 9.45% as non-pathogenic. The model showed that there co

FAQs

What problem does the study address in urinary tract infection management?

The study targets the difficulty of distinguishing true pathogens from commensals, colonizers, or contaminants when interpreting urine culture results, which strongly affects treatment decisions.

How does the stepwise model classify urinary isolates?

It uses a structured stepwise approach to determine whether an isolate is pathogenic (commensal, colonizer, or direct pathogen) or non-pathogenic (commensal, colonizer, or contaminant).

What were the main outcomes regarding safety and feasibility?

The model identified about one in ten initially considered pathogenic isolates as non-pathogenic. It is reported as safe and feasible, with potential benefits including reduced hospital stay and antibiotic cost savings in the non-pathogenic cohort.

Sep 29, 2026

Uploaded by Kurz