The antimicrobial treatment guidelines quality and reporting assessment: A systematic review
A Homs-Estévez1, I García-Giménez2, M Durán-Luque3
1University of Granada, Department of Preventive Medicine and Public Health, Spain.
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.
Insights
Antimicrobial treatment guidelines (ATG) in Spain show low methodological quality and reporting. Improvements are needed, especially in hospital settings, to optimize antibiotic prescribing and combat resistance.
Area of Science:
- Health Services Research
- Infectious Diseases
- Clinical Pharmacy
Background:
- Inappropriate antimicrobial use drives resistance.
- Antimicrobial Treatment Guidelines (ATG) are crucial for evidence-based prescribing.
- Trustworthiness of ATGs depends on methodological quality and reporting.
Purpose of the Study:
- To critically appraise the methodological quality and reporting of ATGs in Spain.
- To evaluate ATGs using AGREE II, AGREE-REX, and RIGHT tools.
- To identify areas for improvement in ATG development and implementation.
Main Methods:
- Systematic review of ATGs from public institutions and hospitals.
- Search via Google and AFinf workgroup consultation.
- Duplicate screening and data extraction.
- Assessment using AGREE II, AGREE-REX, and RIGHT checklists.
Main Results:
- Mean scores for AGREE II (31.0%), AGREE-REX (20.4%), and RIGHT (28.7%) were generally low.
- Low rates observed for development rigor, referencing reviews, quality assurance, and conflict of interest disclosure.
- High scores for clarity (94.8%) and implementability (37.7%).
- Strong correlations found between AGREE II, AGREE-REX, and RIGHT scores.
Conclusions:
- Significant room for improvement exists in the quality and reporting of Spanish ATGs.
- Hospital-level ATGs have high potential for optimizing antibiotic prescribing.
- Enhancing ATG quality is essential for combating antimicrobial resistance.
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