Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil.
Multiprofessional Residency Program in Orthopedics and Traumatology, Federal University of São Paulo, Santos, São Paulo, Brazil.
J Eval Clin Pract. 2019 Aug;25(4):591-602. doi: 10.1111/jep.12992. Epub 2018 Jul 19.
RATIONALE, GOALS, AND OBJECTIVES: Clinical practice guidelines (CPGs) for preoperative care have been developed for surgical antimicrobial prophylaxis (SAP). The objective of this study was to synthetize recommendations for SAP based on best-evaluated CPGs.
A systematic literature search for documents related to SAP, published between January 2011 and December 2016, was conducted on MEDLINE (PubMed), EMBASE, and specific CPG websites. Three reviewers independently assessed the rigour of development and editorial independence of CPGs based on domains 3 and 6 of the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. CPGs with domain 3 scores of 50% and greater were selected for synthesis of recommendations. Two reviewers independently extracted CPG recommendations from among these documents. A third reviewer performed the synthesis of recommendations.
The search retrieved 363 documents, of which 29 CPGs were appraised using AGREE II. Only eight (28%) scored 50% and greater in domain 3. Most CPGs addressed topics related to preoperative care, including SAP. No conflicting recommendations were found, and most recommendations were based on clinical practice. The only recommendation for which there was a difference among CPGs was with respect to the time to initiate the administration of antibiotics (1 hour before or close to the time of the surgical incision). Four CPGs provide recommendations that demonstrate concern about inadequate SAP prolongation.
Several CPGs for SAP were developed without the desired methodological rigour or transparency. Synthesis of recommendations for best-evaluated CPGs provides a broad approach owing to the complementarity of the recommendations.
背景、目的和目标：针对手术抗菌预防（SAP）制定了临床实践指南（CPG）。本研究的目的是综合评估最佳 CPG 以制定 SAP 建议。
对 MEDLINE（PubMed）、EMBASE 和特定 CPG 网站上 2011 年 1 月至 2016 年 12 月发表的 SAP 相关文献进行系统的文献检索。三名评审员独立评估 CPG 的制定严谨性和编辑独立性，使用 Appraisal of Guidelines for Research & Evaluation II（AGREE II）工具的第 3 域和第 6 域。选择 CPG 第 3 域评分为 50%及以上的 CPG 进行建议综合。两名评审员从这些文件中独立提取 CPG 建议。第三名评审员进行建议综合。
检索到 363 篇文献，其中 29 篇使用 AGREE II 进行了评估。仅 8 篇（28%）在第 3 域中评分为 50%及以上。大多数 CPG 都涉及术前护理，包括 SAP。未发现相互矛盾的建议，大多数建议均基于临床实践。唯一存在 CPG 差异的建议是关于抗生素给药时间（手术切口前 1 小时或接近手术切口时）。4 篇 CPG 提供了关于 SAP 延长不足的建议。
针对 SAP 制定了几个 CPG，但缺乏理想的方法严谨性或透明度。综合评估最佳 CPG 的建议提供了广泛的方法，因为建议之间具有互补性。
