Unit of Infectious Diseases and Infection Control, Lady Davis Carmel Medical Centre, Haifa, Israel.
Clin Microbiol Infect. 2013 Dec;19(12):1106-14. doi: 10.1111/1469-0691.12348. Epub 2013 Aug 30.
Reliance on evidence-based medicine requires high methodological standards from guideline developers. We sought to determine the methodological quality of guidelines on pneumonia and urinary tract infections (UTIs). We included guidelines published by national or international committees in the last 10 years providing recommendations for antibiotic type or duration. We applied the Appraisal of Guidelines for Research and Evaluation II checklist, adding under each item the specific focus relevant to bacterial infections, addressing antibiotic resistance and local epidemiology. Three assessors scored each guideline independently. Mean aggregated scores, converted to percentage per domain, are presented. We included 13 guidelines on the treatment of pneumonia and seven guidelines for the treatment of UTI. 'Scope and purpose' scored 69.4% for pneumonia and 71.4% for UTI. Guidelines were downgraded for lack of an epidemiological overview relevant to intended users. 'Stakeholder involvement' scored 39.5% for pneumonia and 44.5% UTI, with the major fault being lack of patient consultation. 'Rigour of development' scored 42.8% for pneumonia and 56.9% for UTI. Commonly, the search process lacked precision, no risk of bias assessment was performed, outcomes in primary studies were not critically assessed or used to direct recommendations, and there was no formal methodology for formulating recommendations. 'Clarity of presentation' scored highest: 67.7% for pneumonia and 68.5% for UTI. 'Applicability' of the guidelines in antibiotic stewardship programmes was usually not addressed: 16.9% and 25.4%, respectively. 'Editorial independence' scored 30.6% for pneumonia and 55.6% for UTI. Formal examination of guidelines in infectious diseases showed worrying findings related to core methodology and potential bias caused by competing interests.
基于循证医学的决策需要指南制定者具备较高的方法学标准。我们旨在评估肺炎和尿路感染（UTI）相关指南的方法学质量。我们纳入了近 10 年来由国家或国际委员会发布的针对抗生素类型或疗程推荐的指南。我们应用了 AGREE II 工具进行评估，并在每个条目下添加了与细菌感染、抗生素耐药性和当地流行病学相关的具体重点。由 3 名评估员独立对每条指南进行评分。呈现的是每个领域的平均综合评分（转化为百分比）。我们共纳入了 13 条肺炎治疗指南和 7 条 UTI 治疗指南。肺炎指南的“范围和目的”得分为 69.4%，UTI 指南为 71.4%。由于缺乏针对目标用户的流行病学综述，指南的等级有所下降。肺炎指南的“利益相关者参与”得分为 39.5%，UTI 指南为 44.5%，主要问题是缺乏患者咨询。肺炎指南的“制定严谨性”得分为 42.8%，UTI 指南为 56.9%。通常情况下，检索过程不够精确，没有进行偏倚风险评估，未对原始研究的结局进行严格评估或用于指导推荐，也没有正式的方法来制定推荐意见。“报告清晰度”得分最高：肺炎指南为 67.7%，UTI 指南为 68.5%。在抗生素管理项目中，指南的“适用性”通常未得到解决：肺炎指南为 16.9%，UTI 指南为 25.4%。肺炎指南的“编辑独立性”得分为 30.6%，UTI 指南为 55.6%。对传染病相关指南的正式评估发现了一些令人担忧的核心方法学问题和潜在的利益冲突偏倚。
