PDF(Pubmed)
Abstract：
UNASSIGNED: COVID-19 and antimicrobial resistance (AMR) are two intersecting public health crises. Antimicrobial overuse in patients with COVID-19 threatens to worsen AMR. Guidelines are fundamental in encouraging antimicrobial stewardship. We sought to assess the quality of antibiotic prescribing guidelines and recommendations in the context of COVID-19, and whether they incorporate principles of antimicrobial stewardship.
UNASSIGNED: We performed a systematic survey which included a search using the concepts \"antibiotic/antimicrobial\" up to November 15, 2022 of the eCOVID-19 living map of recommendations (RecMap) which aggregates guidelines across a range of international sources and all languages. Guidelines providing explicit recommendations regarding antibacterial use in COVID-19 were eligible for inclusion. Guideline and recommendation quality were assessed using the AGREE II and AGREE-REX instruments, respectively. We extracted guideline characteristics including panel representation and the presence or absence of explicit statements related to antimicrobial stewardship (i.e., judicious antibiotic use, antimicrobial resistance or adverse effects as a consequence of antibiotic use). We used logistic regression to evaluate the relationship between guideline characteristics including quality and incorporation of antimicrobial stewardship principles. Protocol registration (OSF): https://osf.io/4pgtc.
UNASSIGNED: Twenty-eight guidelines with 63 antibiotic prescribing recommendations were included. Recommendations focused on antibiotic initiation (n = 52, 83%) and less commonly antibiotic selection (n = 13, 21%), and duration of therapy (n = 15, 24%). Guideline and recommendation quality varied widely. Twenty (71%) guidelines incorporated at least one concept relating to antimicrobial stewardship. Including infectious diseases expertise on the guideline panel (OR 9.44, 97.5% CI: 1.09-81.59) and AGREE-REX score (OR 3.26, 97.5% CI: 1.14-9.31 per 10% increase in overall score) were associated with a higher odds of guidelines addressing antimicrobial stewardship.
UNASSIGNED: There is an opportunity to improve antibiotic prescribing guidelines in terms of both quality and incorporation of antimicrobial stewardship principles. These findings can help guideline developers better address antibiotic stewardship in future recommendations beyond COVID-19.
UNASSIGNED: This project was funded by Michael G. DeGroote Cochrane Canada and McMaster GRADE centres.
UNASSIGNED: We performed a systematic survey which included a search using the concepts \"antibiotic/antimicrobial\" up to November 15, 2022 of the eCOVID-19 living map of recommendations (RecMap) which aggregates guidelines across a range of international sources and all languages. Guidelines providing explicit recommendations regarding antibacterial use in COVID-19 were eligible for inclusion. Guideline and recommendation quality were assessed using the AGREE II and AGREE-REX instruments, respectively. We extracted guideline characteristics including panel representation and the presence or absence of explicit statements related to antimicrobial stewardship (i.e., judicious antibiotic use, antimicrobial resistance or adverse effects as a consequence of antibiotic use). We used logistic regression to evaluate the relationship between guideline characteristics including quality and incorporation of antimicrobial stewardship principles. Protocol registration (OSF): https://osf.io/4pgtc.
UNASSIGNED: Twenty-eight guidelines with 63 antibiotic prescribing recommendations were included. Recommendations focused on antibiotic initiation (n = 52, 83%) and less commonly antibiotic selection (n = 13, 21%), and duration of therapy (n = 15, 24%). Guideline and recommendation quality varied widely. Twenty (71%) guidelines incorporated at least one concept relating to antimicrobial stewardship. Including infectious diseases expertise on the guideline panel (OR 9.44, 97.5% CI: 1.09-81.59) and AGREE-REX score (OR 3.26, 97.5% CI: 1.14-9.31 per 10% increase in overall score) were associated with a higher odds of guidelines addressing antimicrobial stewardship.
UNASSIGNED: There is an opportunity to improve antibiotic prescribing guidelines in terms of both quality and incorporation of antimicrobial stewardship principles. These findings can help guideline developers better address antibiotic stewardship in future recommendations beyond COVID-19.
UNASSIGNED: This project was funded by Michael G. DeGroote Cochrane Canada and McMaster GRADE centres.
摘要：
■COVID-19和抗菌素耐药性（AMR）是两个交叉的公共卫生危机。COVID-19患者的抗菌药物过度使用有可能使AMR恶化。指南是鼓励抗菌药物管理的基础。我们试图评估COVID-19背景下抗生素处方指南和建议的质量，以及它们是否纳入了抗菌药物管理原则。
我们进行了一项系统调查，其中包括使用“抗生素/抗菌”概念进行搜索，截至2022年11月15日，eCOVID-19推荐生活地图（RecMap）汇总了一系列国际来源和所有语言的指南。提供关于COVID-19抗菌药物使用的明确建议的指南符合纳入条件。使用AGREEII和AGREE-REX工具评估指南和推荐质量，分别。我们提取了指南特征，包括小组代表和是否存在与抗菌药物管理相关的明确陈述(即，明智的抗生素使用，抗生素耐药性或由于抗生素使用而产生的不利影响)。我们使用逻辑回归来评估指南特征之间的关系，包括质量和纳入抗菌药物管理原则。协议注册(OSF)：https://osf.io/4pgtc。
■包括28个指南和63个抗生素处方建议。建议侧重于抗生素起始（n=52，83％）和较不常见的抗生素选择（n=13，21％），和治疗持续时间（n=15，24%）。指南和推荐质量差异很大。20（71％）指南纳入了至少一个与抗菌药物管理有关的概念。包括指南面板中的传染病专业知识（OR9.44，97.5％CI：1.09-81.59）和AGREE-REX评分（OR3.26，97.5％CI：1.14-9.31/10总评分增加）与更高的指南解决抗菌药物管理的几率相关。
■有机会在质量和纳入抗菌药物管理原则方面改进抗生素处方指南。这些发现可以帮助指南开发人员在COVID-19以外的未来建议中更好地解决抗生素管理问题。
■该项目由MichaelG.DeGrooteCochraneCanada和McMasterGrade中心资助。
我们进行了一项系统调查，其中包括使用“抗生素/抗菌”概念进行搜索，截至2022年11月15日，eCOVID-19推荐生活地图（RecMap）汇总了一系列国际来源和所有语言的指南。提供关于COVID-19抗菌药物使用的明确建议的指南符合纳入条件。使用AGREEII和AGREE-REX工具评估指南和推荐质量，分别。我们提取了指南特征，包括小组代表和是否存在与抗菌药物管理相关的明确陈述(即，明智的抗生素使用，抗生素耐药性或由于抗生素使用而产生的不利影响)。我们使用逻辑回归来评估指南特征之间的关系，包括质量和纳入抗菌药物管理原则。协议注册(OSF)：https://osf.io/4pgtc。
■包括28个指南和63个抗生素处方建议。建议侧重于抗生素起始（n=52，83％）和较不常见的抗生素选择（n=13，21％），和治疗持续时间（n=15，24%）。指南和推荐质量差异很大。20（71％）指南纳入了至少一个与抗菌药物管理有关的概念。包括指南面板中的传染病专业知识（OR9.44，97.5％CI：1.09-81.59）和AGREE-REX评分（OR3.26，97.5％CI：1.14-9.31/10总评分增加）与更高的指南解决抗菌药物管理的几率相关。
■有机会在质量和纳入抗菌药物管理原则方面改进抗生素处方指南。这些发现可以帮助指南开发人员在COVID-19以外的未来建议中更好地解决抗生素管理问题。
■该项目由MichaelG.DeGrooteCochraneCanada和McMasterGrade中心资助。
