“Understanding Clinical Variances in Urinary Isolates: Pathogenic Vs. Non-Pathogenic Impacts in Tertiary Healthcare of North India”

INTRODUCTION: The clinical decision-making landscape in urinary tract infections (UTIs) hinges on discerning between pathogenic and non-pathogenic organisms. The accurate interpretation of culture results relies significantly on precise collection methods, the patient's clinical status, and organism characteristics. This pioneering study, the first of its kind, systematically examines the clinical outcomes associated with pathogenic and non-pathogenic urinary isolates. Nestled within the tertiary healthcare context, this research not only fills a critical knowledge gap but also endeavors to unravel the economic and clinical implications that underscore the distinctive nature of UTIs in North India. OBJECTIVE: To conduct a comprehensive assessment of the clinical and economic impacts of urinary tract infections (UTIs) caused by pathogenic and non-pathogenic organisms in North India's tertiary healthcare. Evaluate hospitalization duration, antimicrobial usage, costs, mortality rates, and patient demographics to inform customized management strategies, optimize resource allocation, and enhance overall UTI patient care. METHODOLOGY: Conducted at AIIMS Rishikesh, a longitudinal-exploratory study over 18 months included 275 participants meeting specific criteria. Data entry via Redcap ensured precision. SPSS (Version 23) facilitated statistical analysis encompassing chi-square tests and logistic regression, prioritizing ethical considerations and patient consent. RESULTS: Pathogenic Cases: Comprising 90.54% of the cohort, average hospital stays of 14.68 days, and expenses of $29.12 on antibiotics with a mortality rate of 3.6%. Pathogenic-Commensal Cases: Constituting 61.81% with an average stay of 13.88 days, antibiotic expenses at $28.46 and a mortality rate of 3.2%. Pathogenic Colonizer Cases: Accounting for 14.18%, with an average stay of 14.67 days, antibiotic expenses at $27.69 and a mortality rate of 0.36%. Direct Pathogenic Cases: Representing 14.54% with longer stays (18.08 days) and higher antibiotic expenses $33.28. Non-Pathogenic Cases: Makeup 9.45% with variable stays and expenses. DISCUSSION: This ground-breaking study explores clinical variances in urinary isolates, distinguishing pathogenic (90.54%) and non-pathogenic cases (9.45%). Subtypes within pathogenic cases offer nuanced insights, guiding tailored patient care and optimizing resources. Non-pathogenic cases, though fewer, reveal variability, emphasizing the study's depth. Recognizing the clinical impact of seemingly benign isolates becomes crucial amid rising antimicrobial resistance, urging judicious antimicrobial prescription. CONCLUSION: This study pioneers insights into North India's urinary isolates, emphasizing customized management. Distinguishing pathogenic from non-pathogenic cases, especially subtypes, is imperative. Identifying and avoiding unnecessary antimicrobial use emerge as pivotal interventions, contributing significantly to global antimicrobial resistance efforts and alleviating economic burdens on healthcare systems worldwide.### Competing Interest StatementThe authors have declared no competing interest.### Funding StatementThis study did not receive any funding### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:Approval from the Institutional Ethics Committee, AIIMS (DHR REG NO: EC/NEW/INST/UA/0180) and with approval number 295/IEC/PGM/2022I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesAll data produced in the present study are available upon reasonable request to the authors All data produced in the present work are contained in the manuscript