Division of General Internal Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada.
Montgomery Medical Associates, Rockville, Maryland.
JAMA Netw Open. 2023 Jul 3;6(7):e2326366. doi: 10.1001/jamanetworkopen.2023.26366.
Practice guidelines often provide recommendations in which the strength of the recommendation is dissociated from the quality of the evidence.
To create a clinical guideline for the diagnosis and management of adult bacterial infective endocarditis (IE) that addresses the gap between the evidence and recommendation strength.
This consensus statement and systematic review applied an approach previously established by the WikiGuidelines Group to construct collaborative clinical guidelines. In April 2022 a call to new and existing members was released electronically (social media and email) for the next WikiGuidelines topic, and subsequently, topics and questions related to the diagnosis and management of adult bacterial IE were crowdsourced and prioritized by vote. For each topic, PubMed literature searches were conducted including all years and languages. Evidence was reported according to the WikiGuidelines charter: clear recommendations were established only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were crafted discussing the risks and benefits of different approaches.
A total of 51 members from 10 countries reviewed 587 articles and submitted information relevant to 4 sections: establishing the diagnosis of IE (9 questions); multidisciplinary IE teams (1 question); prophylaxis (2 questions); and treatment (5 questions). Of 17 unique questions, a clear recommendation could only be provided for 1 question: 3 randomized clinical trials have established that oral transitional therapy is at least as effective as intravenous (IV)-only therapy for the treatment of IE. Clinical reviews were generated for the remaining questions.
In this consensus statement that applied the WikiGuideline method for clinical guideline development, oral transitional therapy was at least as effective as IV-only therapy for the treatment of IE. Several randomized clinical trials are underway to inform other areas of practice, and further research is needed.
实践指南通常提供建议，其中建议的强度与证据的质量是分开的。
制定成人细菌性感染性心内膜炎（IE）的诊断和管理临床指南，以解决证据与推荐强度之间的差距。
本共识声明和系统评价采用了 WikiGuidelines 小组先前建立的方法来构建协作临床指南。2022 年 4 月，向新成员和现有成员发布了关于下一个 WikiGuidelines 主题的电子（社交媒体和电子邮件）呼吁，随后通过投票对与成人细菌性 IE 的诊断和管理相关的主题和问题进行了众包和优先排序。对于每个主题，都进行了包括所有年份和语言的 PubMed 文献检索。证据是根据 WikiGuidelines 章程报告的：只有当可重复、前瞻性、对照研究提供证实假设的证据时，才会制定明确的建议。在缺乏此类数据的情况下，临床综述讨论了不同方法的风险和益处。
来自 10 个国家的 51 名成员审查了 587 篇文章，并提交了与 4 个部分相关的信息：确立 IE 的诊断（9 个问题）；多学科 IE 团队（1 个问题）；预防（2 个问题）；和治疗（5 个问题）。在 17 个独特的问题中，只有一个问题可以提供明确的建议：3 项随机临床试验已经证实，口服过渡治疗与静脉（IV）仅治疗 IE 一样有效。对于其余的问题，生成了临床综述。
在应用 WikiGuideline 方法制定临床指南的本共识声明中，口服过渡治疗与 IV 仅治疗 IE 的治疗效果至少一样好。目前正在进行几项随机临床试验，以提供其他实践领域的信息，需要进一步研究。
