HealthPartners and Park Nicollet Health Services, St Louis Park, Minnesota.
The University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Queensland, Australia.
JAMA Netw Open. 2024 Nov 4;7(11):e2444495. doi: 10.1001/jamanetworkopen.2024.44495.
Traditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality of evidence.
To create a clinical guideline for the diagnosis and management of urinary tract infections 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 May 2023, new and existing members were solicited for questions on urinary tract infection prevention, diagnosis, and management. For each topic, literature searches were conducted up until early 2024 in any language. 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 developed discussing the available literature and associated risks and benefits of various approaches.
A total of 54 members representing 12 countries reviewed 914 articles and submitted information relevant to 5 sections: prophylaxis and prevention (7 questions), diagnosis and diagnostic stewardship (7 questions), empirical treatment (3 questions), definitive treatment and antimicrobial stewardship (10 questions), and special populations and genitourinary syndromes (10 questions). Of 37 unique questions, a clear recommendation could be provided for 6 questions. In 3 of the remaining questions, a clear recommendation could only be provided for certain aspects of the question. Clinical reviews were generated for the remaining questions and aspects of questions not meeting criteria for a clear recommendation.
In this consensus statement that applied the WikiGuidelines method for clinical guideline development, the majority of topics relating to prevention, diagnosis, and treatment of urinary tract infections lack high-quality prospective data and clear recommendations could not be made. Randomized clinical trials are underway to address some of these gaps; however further research is of utmost importance to inform true evidence-based, rather than eminence-based practice.
传统的实践指南方法常常导致推荐强度和证据质量之间脱节。
制定一个用于诊断和管理尿路感染的临床指南，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应用了 WikiGuidelines 小组先前建立的方法来构建协作临床指南。在 2023 年 5 月，向新老成员征求有关尿路感染预防、诊断和管理的问题。对于每个主题，在任何语言中都进行了截至 2024 年初的文献检索。证据是根据 WikiGuidelines 章程报告的：只有当可重复、前瞻性、对照研究提供了证实假说的证据时，才会制定明确的建议。在缺乏此类数据的情况下，制定了临床综述，讨论了各种方法的现有文献以及相关的风险和收益。
共有 54 名代表 12 个国家的成员审查了 914 篇文章，并提交了与 5 个部分相关的信息：预防和预防（7 个问题）、诊断和诊断管理（7 个问题）、经验性治疗（3 个问题）、确定性治疗和抗菌药物管理（10 个问题）以及特殊人群和泌尿生殖综合征（10 个问题）。在 37 个独特的问题中，有 6 个问题可以提供明确的建议。在其余 3 个问题中，只能为问题的某些方面提供明确的建议。对于不符合明确建议标准的其余问题和问题方面，生成了临床综述。
在本共识声明中，应用了 WikiGuidelines 方法来制定临床指南，大多数与预防、诊断和治疗尿路感染相关的主题缺乏高质量的前瞻性数据，无法提出明确的建议。正在进行随机临床试验来解决其中的一些差距；然而，进一步的研究至关重要，可以为真正的基于证据而不是基于权威的实践提供信息。
