OBJECTIVE: The aim of this GISIG (Gruppo Italiano di Studio sulle Infezioni Gravi) working group - a panel of multidisciplinary experts - was to define recommendations for some controversial issues using an evidence-based and analytical approach. The controversial issues were: (1) Is combination antibiotic therapy or monotherapy more effective in the treatment of HAP? (2) What role do pharmacokinetic/pharmacodynamic antibiotic features have as a guide in the selection of treatment for HAP? (3) Is a de-escalation approach for the management of HAP effective? An analysis of the studies published up until April 2009 is presented and discussed in detail.
METHODS: A systematic literature search using PubMed, MEDLINE, and EMBASE databases and the Cochrane Library was performed. A matrix was created to extract evidence from original studies using the CONSORT method to evaluate randomized clinical trials and the Newcastle-Ottawa Quality Assessment Scale for case-control studies, longitudinal cohorts, and retrospective studies. The GRADE method for grading quality of evidence was applied.
目标:这个GISIG(GruppoItalianodiStudiosulleInfezioniGravi)工作组——一个多学科专家小组——的目标是使用基于证据的分析方法为一些有争议的问题定义建议。有争议的问题是:(1)联合抗生素疗法或单一疗法在治疗HAP方面更有效吗?(2)药代动力学/药效学抗生素特征在选择HAP治疗方面具有什么作用?(3)HAP管理的降级方法是否有效?对截至2009年4月发表的研究进行了分析并进行了详细讨论。
方法:使用PubMed进行系统的文献检索,MEDLINE,和EMBASE数据库和Cochrane图书馆进行。使用CONSORT方法从原始研究中提取证据,以评估随机临床试验和用于病例对照研究的纽卡斯尔-渥太华质量评估量表,纵向队列,和回顾性研究。采用分级方法对证据质量进行分级。