目的：本研究旨在评估碳青霉烯类耐药革兰阴性杆菌（CRGNB）感染的临床实践指南（CPGs），并总结建议。
方法：对2012年1月至2023年3月发表的文献进行系统检索，以确定与CRGNB感染治疗相关的CPG。使用研究与评估指南评估（AGREE）II工具的六个领域和HealThcare实践指南报告项目的七个领域（右）清单评估了合格CPG的方法和报告质量。提取并比较纳入CPG的基本信息和建议。
结果：共纳入7953篇相关文章的21篇CPG。平均总体AGREEII评分为62.7%，“陈述清晰度”最高（90.2%），“利益相关者参与”最低（44.8%）。所有CPG的总体报告质量均欠佳，符合条件的项目比例从45.7%到85.7%不等。CRGNB感染的治疗与病原体的类型有关，抗菌药物的敏感性，和感染部位。总的来说,推荐的方案主要包括新型β-内酰胺/β-内酰胺酶抑制剂，cefiderocol,氨苄西林-舒巴坦（主要用于耐碳青霉烯鲍曼不动杆菌[CRAB]），和联合治疗，涉及多粘菌素B/粘菌素，替加环素（耐碳青霉烯类铜绿假单胞菌除外），氨基糖苷类,碳青霉烯类,磷霉素,和舒巴坦（主要用于CRAB）。
结论：用于治疗CRGNB感染的CPGs的方法学和报告质量普遍欠佳，需要进一步改进。新型药物的单一疗法和联合疗法在治疗中起着重要作用。
OBJECTIVE: This study aimed to appraise clinical practice
guidelines (CPGs) for the treatment of carbapenem-resistant Gram-negative Bacilli (CRGNB) infections and to summarise the recommendations.
METHODS: A systematic search of the literature published from January 2012 to March 2023 was undertaken to identify CPGs related to CRGNB infections treatment. The methodological and reporting quality of eligible CPGs were assessed using six domains of the Appraisal of
Guidelines for Research and Evaluation (AGREE) II tool and seven domains of the Reporting Items for practice
Guidelines in HealThcare (RIGHT) checklist. Basic information and recommendations of included CPGs were extracted and compared.
RESULTS: A total of 21 CPGs from 7953 relevant articles were included. The mean overall AGREE II score was 62.7%, and was highest for \"clarity of presentation\" (90.2%) and lowest for \"stakeholder involvement\" (44.8%). The overall reporting quality of all of the CPGs was suboptimal, with the proportion of eligible items ranging from 45.7 to 85.7%. The treatment of CRGNB infections is related to the type of pathogen, the sensitivity of antimicrobial agents, and the site of infection. In general, the recommended options mainly included novel β-lactam/ β-lactamase inhibitors,
cefiderocol, ampicillin-sulbactam (mainly for carbapenem-resistant Acinetobacter baumannii [CRAB]), and combination therapy, involving polymyxin B/colistin, tigecycline (except for carbapenem-resistant Pseudomonas aeruginosa), aminoglycosides, carbapenems, fosfomycin, and sulbactam (mainly for CRAB).
CONCLUSIONS: The methodological and reporting quality of CPGs for the treatment of CRGNB infections are generally suboptimal and need further improvement. Both monotherapy with novel drugs and combination therapy play important roles in the treatment.
