Assessment of Quality in Antimicrobial Calcium Phosphate Research (AQUACAP): A Systematic Review

The effectiveness of antimicrobial ion-substituted calcium phosphate biomaterials has been investigated in numerous studies, but reporting guidelines and quality checklists are missing. A novel quality checklist was created for assessing reporting and methodological quality by experts of relevant disciplines. The checklist consisted of 20 items for reporting quality (maximum score 32) and 11 for methodological quality (maximum score 18). The checklist was subsequently implemented to assess the reporting and methodological quality of 58 studies in this field. Possible associations between study quality, year of publication and citations were investigated, and items for improvement were identified. Main items for improvement in reporting quality (average score 18/32) were reporting variability and statistics of data, reporting rationales for study design and the clinical relevance of the outcomes. Methodological quality (average score 11/18) could be improved by including positive control groups, using clinically relevant material formulations and including tests of the material toxicity. No association was found between study quality and year of publication. Methodological quality was associated with a higher number of annual citations. This study identifies key areas for improvement of reporting and methodological quality in the field of ion-substituted antimicrobial calcium phosphates. With these findings, the quality of future studies on antimicrobial CaP materials can be improved. The new quality checklist can also be used to improve study design for future research and enables better comparison between study outcomes.