-->PONE-D-25-63614-->-->Multicenter Evaluation of BACT-Info. and an Infection Algorithm Using Urine Flow Cytometry among Clinically Diagnosed UTI Patients in Indonesia-->-->PLOS One

Dear Dr. Dahesihdewi,

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Academic Editor

PLOS One

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Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. -->

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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-->2. Has the statistical analysis been performed appropriately and rigorously? -->

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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-->3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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-->4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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-->5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: I think the authors of this manuscript have done a really good job.

I recommend that they have a closer look at some typos or grammatical errors. For example line 147: "...urine culture resulted..." maybe you meant results?

Reviewer #2: The subject is of great interest and the paper can be improved by performing the requested modifications.

Line 90: it would be helpful for the reader to explain what “time-consuming” means in the context of a urine culture.

Line 98: Is an automated urinalysis system using flow cytometry expensive? Could it be compared with conventional urine analysis in terms of cost?

Line 102: Please clearly describe “UTI-Info. and BACT-Info” to introduce these terms to the reader.

Line 171: remove the point and line after ‘accuracy”

Line 293: correct “cutoffs” to “cut-offs”

Reviewer #3: 1- The manuscript refers to an “infection algorithm,” but the description is insufficient for reproducibility. Please clearly explain how the algorithm works, including the thresholds, parameters used, and whether it was predefined by the manufacturer or developed within the study. Although the manuscript states that suspected UTI patients were recruited from multiple centers, the criteria used to define “suspected UTI” should be described more explicitly to ensure reproducibility and minimize selection bias. The manuscript should clearly explain how contaminated samples or mixed bacterial growth were classified and whether these samples were excluded from the final diagnostic accuracy analysis. Please clarify whether the investigators interpreting the UF-5000 results were blinded to urine culture results and vice versa. Proper blinding is essential to minimize diagnostic review bias.

2-The statistical analysis section should include more detailed descriptions of how sensitivity, specificity, predictive values, and likelihood ratios were calculated, including the software used and the confidence intervals applied. While the UF-5000 system demonstrated high sensitivity, the reported specificity is relatively modest. The authors should provide a deeper discussion on the clinical implications of this finding, particularly the potential for false positives and unnecessary follow-up testing. If possible, the authors should present subgroup analyses based on patient characteristics (e.g., sex, inpatient vs. outpatient, age groups). Such analyses could improve understanding of the test's performance across different populations.

3- While the authors cite previous studies evaluating urine flow cytometry systems, the discussion would benefit from a more detailed comparison of diagnostic performance metrics with previously published research. The manuscript would be strengthened by outlining how this screening approach could be implemented in routine clinical laboratories, including potential benefits in reducing unnecessary urine cultures and improving laboratory efficiency.

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Reviewer #1: No

Reviewer #2: Yes: Mihaela Anca DASCALU

Reviewer #3: Yes: HAMZA ISLAM

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Attachments

Attachment

Submitted filename: Minor revision.docx

Multicenter Evaluation of BACT-Info. and an Infection Algorithm Using Urine Flow Cytometry among Clinically Diagnosed UTI Patients in Indonesia

PONE-D-25-63614R1

Dear Dr. Dahesihdewi,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Ennio Polilli

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.-->

Reviewer #2: All comments have been addressed

Reviewer #3: All comments have been addressed

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-->2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. -->

Reviewer #2: Yes

Reviewer #3: Yes

**********

-->3. Has the statistical analysis been performed appropriately and rigorously? -->

Reviewer #2: Yes

Reviewer #3: Yes

**********

-->4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->

Reviewer #2: Yes

Reviewer #3: Yes

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-->5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #2: Yes

Reviewer #3: Yes

**********

-->6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #2: (No Response)

Reviewer #3: This version has satisfied my comments. Good job done. Good Luck.

All my comments related to statistiscal method are done accurately. Similarly the discussion is modified and I think this revised version should be published.

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-->7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review?  For information about this choice, including consent withdrawal, please see our Privacy Policy.-->

Reviewer #2: Yes: Mihaela Anca DASCALU

Reviewer #3: Yes: Hamza Islam

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