Prevention of Clostridium difficile Infection: A Systematic Survey of Clinical Practice Guidelines.
BACKGROUND Clostridium difficile infection (CDI) is the most common cause of hospital-acquired infectious diarrhea. OBJECTIVE To analyze the methodological quality, content, and supporting evidence among clinical practice guidelines (CPGs) on CDI prevention. DESIGN AND SETTING We searched medical databases and gray literature for CPGs on CDI prevention published January 2004-January 2015. Three reviewers independently screened articles and rated CPG quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, composed of 23 items, rated 1-7, within 6 domains. We reported each domain score as a percentage of its maximum possible score and standardized range. We summarized recommendations, extracted their supporting articles, and rated individually the level of evidence using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS Of 2,578 articles screened, 5 guidelines met inclusion criteria. Median AGREE II scores and interquartile ranges were: clarity of presentation, 75.9% (75.9%-79.6%); scope and purpose, 74.1% (68.5%-85.2%); editorial independence, 63.9% (47.2%-66.7%); applicability, 43.1% (19.4%-55.6%); stakeholder involvement, 40.7% (38.9%-44.4%); and rigor of development, 18.1% (17.4%-35.4%). CPGs addressed several common strategies for CDI prevention, including antibiotic stewardship, hypochlorite solutions, probiotic prophylaxis, and bundle strategies. Recommendations were often not consistent with evidence, and most were based on low-level studies. CONCLUSION CPGs did not adhere well to AGREE II reporting standards. Furthermore, there was limited transparency in moving from evidence to recommendations. CDI prevention CPGs need to better adhere to AGREE-II and be transparent in moving from evidence to recommendations, and recommendations need to be consistent with available evidence. Infect Control Hosp Epidemiol 2016;37:901-908.
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.|Systematic Overviews through advancing Research Technology (SORT), Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.
Lyubov
L
Lytvyn
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.|Department of Medicine, McMaster University, Hamilton, Canada.|Michael G. DeGroote Institute for Infectious Diseases Research, McMaster University, Hamilton, Canada.
Dominik
D
Mertz
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.|Regional Knowledge Hub and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Behnam
B
Sadeghirad
Department of Pediatric Infectious Disease, King Saud Medical City, Riyadh, Saudi Arabia.
Faisal
F
Alaklobi
Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain.|CIBER de Epidemiologia y Salud Publica, Barcelona, Spain.
Anna
A
Selva
Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain.|CIBER de Epidemiologia y Salud Publica, Barcelona, Spain.
Pablo
P
Alonso-Coello
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.|Systematic Overviews through advancing Research Technology (SORT), Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.|Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.|Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Bradley C
BC
Johnston
D002985:Clinical Protocols; D003015:Clostridium Infections / Q000517:prevention & control*; D003428:Cross Infection / Q000517:prevention & control; D019317:Evidence-Based Medicine; D006801:Humans