Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
BMJ Open. 2021 Jul 30;11(7):e046097. doi: 10.1136/bmjopen-2020-046097.
Guidelines that include antimicrobial recommendations should explicitly consider contextual factors that influence antimicrobial resistance and their downstream effects on resistance selection. The objectives were to analyse (1) how, and to what extent, tuberculosis, gonorrhoea and respiratory tract infection guidelines are considering antimicrobial resistance; (2) are of acceptable quality and (3) if they can be easily contextualised to fit the needs of specific populations and health systems.
We conducted a systematic review and searched Ovid MEDLINE and Embase from 1 January 2007 to 7 June 2019 for tuberculosis, gonorrhoea and respiratory tract infection guidelines published in English. We also searched guideline databases, key websites and reference lists. We identified guidelines and recommendations that considered contextual factors including antimicrobial resistance, values, resource use, equity, acceptability and feasibility. We assessed quality of the guidelines using the Appraisal of Guidelines for Research and Evaluation II tool focusing on the domains scope and purpose, rigour of development, and editorial independence.
We screened 10 365 records, of which 74 guidelines met inclusion criteria. Of these guidelines, 39% (n=29/74) met acceptable quality scores. Approximately two-thirds of recommendations considered antimicrobial resistance at the population and/or outcome level. Five of the 29 guidelines reported all factors required for recommendation contextualisation. Equity was the least considered across guidelines.
Relatively few guidelines for highly prevalent infectious diseases are considering resistance at a local level, and many do not consider contextual factors necessary for appropriate antimicrobial use. Improving the quality of guidelines targeting specific regional areas is required.
CRD42020145235.
包含抗菌药物推荐的指南应明确考虑影响抗菌药物耐药性的背景因素及其对耐药性选择的下游影响。目的是分析：(1) 结核病、淋病和呼吸道感染指南是如何考虑抗菌药物耐药性的，以及考虑的程度；(2) 指南的质量是否可以接受；(3) 指南是否易于根据特定人群和卫生系统的需求进行调整。
我们进行了一项系统评价，检索了 Ovid MEDLINE 和 Embase 数据库，时间范围为 2007 年 1 月 1 日至 2019 年 6 月 7 日，以获取以英文发表的结核病、淋病和呼吸道感染指南。我们还检索了指南数据库、主要网站和参考文献列表。我们确定了考虑背景因素（包括抗菌药物耐药性、价值观、资源利用、公平性、可接受性和可行性）的指南和建议。我们使用评估研究和评价 II 工具评估指南的质量，重点关注范围和目的、开发严谨性以及编辑独立性等领域。
我们筛选了 10365 条记录，其中 74 条指南符合纳入标准。在这些指南中，39%（n=29/74）符合可接受的质量评分标准。大约三分之二的建议考虑了人群和/或结果层面的抗菌药物耐药性。29 条指南中有 5 条报告了推荐调整所需的所有因素。公平性是指南中考虑最少的因素。
针对高流行传染病的相对较少的指南考虑了当地耐药性问题，并且许多指南没有考虑适当使用抗菌药物所需的背景因素。需要提高针对特定地区的指南的质量。
PROSPERO 注册号：CRD42020145235。
