Exploring the feasibility and synergistic value of the One Health approach in clinical research: protocol for a prospective observational study of diagnostic pathways in human and canine patients with suspected urinary tract infection

Gloria Cordoba, Tina Møller Sørensen, Anne Holm, Charlotte Reinhard Bjørnvad, Lars Bjerrum, Lisbeth Rem Jessen, Gloria Cordoba, Tina Møller Sørensen, Anne Holm, Charlotte Reinhard Bjørnvad, Lars Bjerrum, Lisbeth Rem Jessen

Abstract

Background: The One Health approach is emerging in response to the development of bacterial resistance. To the best of our knowledge, the possibility to use this approach in a clinical context has not yet been explored. Thus, in this paper, we report the procedures to implement a prospective observational study of diagnostic pathways in human and canine patients with suspected urinary tract infection as a means to assess the feasibility and synergistic value of setting up One Health clinical research projects and interventions.

Methods/design: A prospective observational study will compare different diagnostic pathways (i.e., 16 possible combinations of diagnostic tools) to gold standard in human and veterinary primary care practice in Denmark. Fifty primary care practices and 100 veterinary clinics will each consecutively include 20 human patients or 8-10 dogs, respectively. Data will be collected at practice and patient level comprising (a) information about the organization of the practice and access to different diagnostic tools, (b) information about clinical history, diagnostic path and treatment during the index consultation, (c) information about severity of symptoms during the 7-10 days following inclusion, and (d) urine culture (type of microorganism and susceptibility test). The feasibility and synergistic value of conducting future research, and/or designing common interventions, will be assessed by evaluating the comparability of human primary care and veterinary primary care with respect to study implementation and study results.

Discussion: Results from this study will give an insight into the feasibility and synergistic value of setting-up One Health research projects in a clinical context. This is crucial if we are to embrace the One Health approach, as a legitimate strategy to implement common interventions aimed at influencing the diagnostic process in human and canine patients in order to decrease inappropriate use of antibiotics.

Trial registration: The study in humans has been registered in ClinicalTrials.gov NCT02249273.

Keywords: Dysuria; Microbiology; Point-of-care systems.

Figures

Fig. 1
Fig. 1
Diagnostic path in patients with suspected UTI in human and veterinary primary care practices in Denmark. The decision tree illustrates the different diagnostic pathways that can be taken during the diagnostic process of a patient with a suspected UTI. The diagnostic pathways are divided into those pathways in which the result is available during the consultation (signs and symptoms, dipsticks, microscopy) and those in which the result is available 1–3 days after the consultation (culture and susceptibility test in practice, culture and susceptibility test at a reference microbiology laboratory)
Fig. 2
Fig. 2
Data collection flow chart. The diagram shows the phases and milestones of data collection before, during, and after the index consultation in human and veterinary primary care practices
Fig. 3
Fig. 3
Definition of appropriate and inappropriate use of antibiotics. Appropriate use of antibiotics means that the decision about not giving antibiotics is correct as far as the culture is negative or the bacteria is susceptible to the prescribed antibiotic. Inappropriate use of antibiotics can lead to two scenarios: (a) under-treatment: a patient with a positive culture is not given antibiotics or the bacteria are not susceptible to the prescribed antibiotic and (b) over-treatment: a patient with a negative culture is given antibiotics or is unnecessarily treated with a second-line antibiotic

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Source: PubMed

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