The antimicrobial treatment guidelines quality and reporting assessment: A systematic review.

BACKGROUND AND

OBJECTIVE

Inappropriate use of antimicrobial agents accelerates the emergence and spread of resistance. Antimicrobial treatment guidelines (ATG) stand between evidence and clinical practice as they are designed to guide policy decision framework for all stakeholders promoting the prudent use of antimicrobials in bedside care. The trustworthiness of these decision-making instruments relies on their methodological quality and reporting. The aim of this systematic review is to critically appraise the methodological quality and reporting of antimicrobial treatment guidelines using the AGREE II, AGREE-REX tools and the RIGHT checklist respectively.

MATERIALS AND

METHODS

A systematic review was conducted. ATGs from public institutions and hospitals with over 500 beds were identified through a systematic search using the Google search engine and by consulting members of the AFinf workgroup (https://gruposdetrabajo.sefh.es/afinf/en/). Screening and data extraction were performed in duplicate. Quality and reporting were assessed using the validated checklists AGREE II, AGREE REX and RIGHT. Central tendency, dispersion, and correlations were calculated and compared using Student's t-test. Results are de-identified. Prospective protocol: https://osf.io/cey2v

RESULTS

N=22. The mean scores for AGREE II, AGREE-REX, and RIGHT were generally low: 31.0% (95% CI: 23.7%-38.3%), 20.4% (95% CI: 15.6%-25.1%), and 28.7% (95% CI: 23.4%-34.0%) respectively. Low rates were observed for development rigour (10.2%); reference existing reviews (4.6%); quality assurance (4.6%); conflict of interests disclosure (4.6%); values and preferences (1.9%) while clarity (94.8%) and implementability (37.7%) rated the highest. Strong correlations among AGREE II and AGREE-REX (corr=0.9092) and RIGHT (corr=0.9203).

CONCLUSION

There is room for improvement in the quality and reporting of current ATGs in Spain, especially at hospital level, where they have greater potential to optimize antibiotic prescribing practices.