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首页> 外文期刊>Journal of Clinical Pharmacy and Therapeutics >The methodological quality of guidelines for hospital‐acquired pneumonia and ventilator‐associated pneumonia: A systematic review
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The methodological quality of guidelines for hospital‐acquired pneumonia and ventilator‐associated pneumonia: A systematic review

机译：医院收养肺炎和呼吸机相关肺炎准则的方法论质量：系统审查

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Summary What is known and Objectives Clinical practice guidelines serve as a framework for physicians to make decisions and to support best practice for optimizing patient care. However, if the guidelines do not address all the important components of optimal care sufficiently, the quality and validity of the guidelines can be reduced. The objectives of this study were to systematically review current guidelines for hospital‐acquired pneumonia ( HAP ) and ventilator‐associated pneumonia ( VAP ), evaluate their methodological quality and highlight the similarities and differences in their recommendations for empirical antibiotic and antibiotic de‐escalation strategies. Methods This review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐analyses ( PRISMA ) statement. Electronic databases including MEDLINE , CINAHL , PubMed and EMBASE were searched up to September 2017 for relevant guidelines. Other databases such as NICE , Scottish Intercollegiate Guidelines Network ( SIGN ) and the websites of professional societies were also searched for relevant guidelines. The quality and reporting of included guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation II ( AGREE ‐ II ) instrument. Results and discussion Six guidelines were eligible for inclusion in our review. Among 6 domains of AGREE ‐ II , “clarity of presentation” scored the highest (80.6%), whereas “applicability” scored the lowest (11.8%). All the guidelines supported the antibiotic de‐escalation strategy, whereas the majority of the guidelines (5 of 6) recommended that empirical antibiotic therapy should be implemented in accordance with local microbiological data. All the guidelines suggested that for early‐onset HAP / VAP , therapy should start with a narrow spectrum empirical antibiotic such as penicillin or cephalosporins, whereas for late‐onset HAP / VAP , the guidelines recommended the use of a broader spectrum empirical antibiotic such as the penicillin extended spectrum carbapenems and glycopeptides. What is new and Conclusions Expert guidelines promote the judicious use of antibiotics and prevent antibiotic overuse. The quality and validity of available HAP / VAP guidelines would be enhanced by improving their adherence to accepted best practice for the management of HAP and VAP .
机译：摘要众所周知和目标临床实践指南是医生做出决策的框架，并支持优化患者护理的最佳做法。但是，如果指南没有充分解决最佳护理的所有重要组成部分，则可以减少指南的质量和有效性。本研究的目标是系统地审查现有医院肺炎（HAP）和呼吸机相关的肺炎（VAP）的当前准则，评估其方法论质量，并突出了他们对实证抗生素和抗生素去升级策略的建议的相似性和差异。方法本次审查乃根据首选报告项目进行系统性评测和荟萃分析（PRISMA）声明。电子数据库包括Medline，Cinahl，Pubmed和Embase，达到2017年9月以获得相关指南。还搜索了其他数据库，如漂亮，苏格兰互殖的指南网络（符号）和专业社会的网站。使用评估和评估指南II（同意 - II）仪器评估，评估所包含的准则的质量和报告。结果和讨论六条指南有资格纳入我们的审核。在同意的6个域名 - II领域中，“陈述清晰度”得分最高（80.6％），而“适用性”得分最低（11.8％）。所有指南都支持抗生素去升级策略，而大多数指南（5个）建议应根据当地微生物数据进行经验抗生素治疗。所有指南都表明，对于早期发作的HAP / VAP，治疗应该从狭窄的频谱经验抗生素如青霉素或头孢菌素开始，而对于晚期发作HAP / VAP，指南建议使用更广泛的谱经验抗生素如青霉素扩展谱碳蛋白和糖肽。什么是新的和结论专家指南促进了抗生素的明智使用并防止抗生素过度使用。通过改善他们的遵守，可以加强可用的HAP / VAP指南的质量和有效性，以接受HAP和VAP管理的最佳实践。

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