An introduction to network meta-analyses in clinical microbiology and infectious diseases

Network meta-analysis (NMA) allows synthesizing results from studies comparing all available interventions. It uses direct evidence from studies directly comparing two interventions (say B and C) but also indirect evidence if there are studies comparing each of B and C to a common comparator (say A). By synthesizing both direct and indirect evidence, NMA allows for the comparison of multiple interventions within a single framework. Additionally, NMA enables comparing interventions that have not been directly compared, provides more precise estimates compared to pairwise meta-analysis, and creates a ranking hierarchy based on any specific outcome.

We aim to provide a thorough introduction to NMA tailored for clinicians and scientists working in the fields of clinical microbiology and infectious diseases.

We illustrated all steps of NMA using a published example from the field of clinical microbiology and infectious diseases. We considered cases and used examples of published NMAs.

We outlined the key concepts and assumptions of NMA using illustrative examples from common infectious diseases. We presented some common pitfalls and misconceptions that are frequently encountered in real-world practice. To reduce the gap between theory and practice, we applied broad steps for conducting and interpreting an NMA to a published NMA evaluating the efficacy of different monotherapies for chronic hepatitis B infection.

By clarifying methodological challenges and providing practical guidance, this paper aims to enhance infectious disease practitioners' understanding of NMA, assuring its proper application and interpretation.