Lytvyn Lyubov, Mertz Dominik, Sadeghirad Behnam, Alaklobi Faisal, Selva Anna, Alonso-Coello Pablo, Johnston Bradley C
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
Systematic Overviews through advancing Research Technology (SORT), Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.
Infect Control Hosp Epidemiol. 2016 Aug;37(8):901-908. doi: 10.1017/ice.2016.104. Epub 2016 Jun 7.
BACKGROUND Clostridium difficile infection (CDI) is the most common cause of hospital-acquired infectious diarrhea. OBJECTIVE To analyze the methodological quality, content, and supporting evidence among clinical practice guidelines (CPGs) on CDI prevention. DESIGN AND SETTING We searched medical databases and gray literature for CPGs on CDI prevention published January 2004-January 2015. Three reviewers independently screened articles and rated CPG quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, composed of 23 items, rated 1-7, within 6 domains. We reported each domain score as a percentage of its maximum possible score and standardized range. We summarized recommendations, extracted their supporting articles, and rated individually the level of evidence using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS Of 2,578 articles screened, 5 guidelines met inclusion criteria. Median AGREE II scores and interquartile ranges were: clarity of presentation, 75.9% (75.9%-79.6%); scope and purpose, 74.1% (68.5%-85.2%); editorial independence, 63.9% (47.2%-66.7%); applicability, 43.1% (19.4%-55.6%); stakeholder involvement, 40.7% (38.9%-44.4%); and rigor of development, 18.1% (17.4%-35.4%). CPGs addressed several common strategies for CDI prevention, including antibiotic stewardship, hypochlorite solutions, probiotic prophylaxis, and bundle strategies. Recommendations were often not consistent with evidence, and most were based on low-level studies. CONCLUSION CPGs did not adhere well to AGREE II reporting standards. Furthermore, there was limited transparency in moving from evidence to recommendations. CDI prevention CPGs need to better adhere to AGREE-II and be transparent in moving from evidence to recommendations, and recommendations need to be consistent with available evidence. Infect Control Hosp Epidemiol 2016;37:901-908.
艰难梭菌感染（CDI）是医院获得性感染性腹泻最常见的病因。目的：分析艰难梭菌感染预防临床实践指南（CPG）的方法学质量、内容及支持证据。设计与环境：我们检索了医学数据库和灰色文献，查找2004年1月至2015年1月发表的关于艰难梭菌感染预防的CPG。三位评审员独立筛选文章，并使用由23个项目组成的《研究与评价指南评估II》（AGREE II）工具对CPG质量进行评分，这些项目在6个领域内评分为1 - 7分。我们将每个领域的得分报告为其最大可能得分的百分比和标准化范围。我们总结了推荐意见，提取了其支持文章，并使用牛津循证医学中心的证据水平对证据水平进行单独评分。结果：在筛选的2578篇文章中，5篇指南符合纳入标准。AGREE II评分中位数及四分位间距为：表述清晰度，75.9%（75.9% - 79.6%）；范围与目的，74.1%（68.5% - 85.2%）；编辑独立性，63.9%（47.2% - 66.7%）；适用性，43.1%（19.4% - 55.6%）；利益相关者参与度，40.7%（38.9% - 44.4%）；制定严谨性，18.1%（17.4% - 35.4%）。CPG涉及了几种常见的艰难梭菌感染预防策略，包括抗生素管理、次氯酸盐溶液、益生菌预防和捆绑策略。推荐意见往往与证据不一致，且大多数基于低水平研究。结论：CPG未很好地遵循AGREE II报告标准。此外，从证据到推荐意见的过程透明度有限。艰难梭菌感染预防CPG需要更好地遵循AGREE - II标准，并在从证据到推荐意见的过程中保持透明，且推荐意见需要与现有证据一致。《感染控制与医院流行病学》2016年；37:901 - 908。
