Evidence supporting recommendations from international guidelines on treatment, diagnosis, and prevention of HAP and VAP in adults
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10400.16/2601 |
Resumo: | Clinical practice guidelines (CPGs) are intended to support clinical decisions and should be based on high-quality evidence. The objective of the study was to evaluate the quality of evidence supporting the recommendations issued in CPGs for therapy, diagnosis, and prevention of hospital-acquired and ventilator-associated pneumonia (HAP/VAP). CPGs released by international scientific societies after year 2000, using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology, were analyzed. Number and strength of recommendations and quality of evidence (high, moderate, low, and very low) were extracted and indexed in the aforementioned sections. High-quality evidence was based on randomized control trials (RCT) without important limitations and exceptionally on rigorous observational studies. Eighty recommendations were assessed, with 7 (8.7%), 24 (30.0%), 29 (36.3%), and 20 (25.0%) being supported by high, moderate, low, and very low-quality evidence, respectively. Highest evidence degree was reported for 26 prevention recommendations, with 7 (26.9%) supported by high-quality evidence and no recommendation based on very low-quality evidence. In contrast, among 9 recommendations for diagnosis and 45 for therapy, none was supported by high-quality evidence, in spite of being recommended as strong in 33.3% and 46.7%, respectively. Among HAP/VAP diagnosis recommendations, the majority of evidence was rated as low or very low-quality (55.6% and 22.2%, respectively) whereas among HAP/VAP therapy recommendations, 4/5 were rated as low and very low-quality (40% each). In conclusion, among HAP/VAP international guidelines, most recommendations, particularly in therapy, remain supported by observational studies, case reports, and expert opinion. Well-designed RCTs are urgently needed. |
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Evidence supporting recommendations from international guidelines on treatment, diagnosis, and prevention of HAP and VAP in adultsClinical practice guidelinesGRADEHospital-acquired pneumoniaQuality of evidenceVentilator-associated pneumoniaClinical practice guidelines (CPGs) are intended to support clinical decisions and should be based on high-quality evidence. The objective of the study was to evaluate the quality of evidence supporting the recommendations issued in CPGs for therapy, diagnosis, and prevention of hospital-acquired and ventilator-associated pneumonia (HAP/VAP). CPGs released by international scientific societies after year 2000, using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology, were analyzed. Number and strength of recommendations and quality of evidence (high, moderate, low, and very low) were extracted and indexed in the aforementioned sections. High-quality evidence was based on randomized control trials (RCT) without important limitations and exceptionally on rigorous observational studies. Eighty recommendations were assessed, with 7 (8.7%), 24 (30.0%), 29 (36.3%), and 20 (25.0%) being supported by high, moderate, low, and very low-quality evidence, respectively. Highest evidence degree was reported for 26 prevention recommendations, with 7 (26.9%) supported by high-quality evidence and no recommendation based on very low-quality evidence. In contrast, among 9 recommendations for diagnosis and 45 for therapy, none was supported by high-quality evidence, in spite of being recommended as strong in 33.3% and 46.7%, respectively. Among HAP/VAP diagnosis recommendations, the majority of evidence was rated as low or very low-quality (55.6% and 22.2%, respectively) whereas among HAP/VAP therapy recommendations, 4/5 were rated as low and very low-quality (40% each). In conclusion, among HAP/VAP international guidelines, most recommendations, particularly in therapy, remain supported by observational studies, case reports, and expert opinion. Well-designed RCTs are urgently needed.SpringerRepositório Científico do Centro Hospitalar Universitário de Santo AntónioCampogiani, LauraTejada, SofiaFerreira-Coimbra, JoãoRestrepo, Marcos I.Rello, Jordi2021-11-22T15:44:36Z20192019-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.16/2601engCampogiani L, Tejada S, Ferreira-Coimbra J, Restrepo MI, Rello J. Evidence supporting recommendations from international guidelines on treatment, diagnosis, and prevention of HAP and VAP in adults. Eur J Clin Microbiol Infect Dis. 2020;39(3):483-491. doi:10.1007/s10096-019-03748-z0934-972310.1007/s10096-019-03748-zinfo:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-10-20T11:01:15Zoai:repositorio.chporto.pt:10400.16/2601Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T20:38:47.925512Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Evidence supporting recommendations from international guidelines on treatment, diagnosis, and prevention of HAP and VAP in adults |
title |
Evidence supporting recommendations from international guidelines on treatment, diagnosis, and prevention of HAP and VAP in adults |
spellingShingle |
Evidence supporting recommendations from international guidelines on treatment, diagnosis, and prevention of HAP and VAP in adults Campogiani, Laura Clinical practice guidelines GRADE Hospital-acquired pneumonia Quality of evidence Ventilator-associated pneumonia |
title_short |
Evidence supporting recommendations from international guidelines on treatment, diagnosis, and prevention of HAP and VAP in adults |
title_full |
Evidence supporting recommendations from international guidelines on treatment, diagnosis, and prevention of HAP and VAP in adults |
title_fullStr |
Evidence supporting recommendations from international guidelines on treatment, diagnosis, and prevention of HAP and VAP in adults |
title_full_unstemmed |
Evidence supporting recommendations from international guidelines on treatment, diagnosis, and prevention of HAP and VAP in adults |
title_sort |
Evidence supporting recommendations from international guidelines on treatment, diagnosis, and prevention of HAP and VAP in adults |
author |
Campogiani, Laura |
author_facet |
Campogiani, Laura Tejada, Sofia Ferreira-Coimbra, João Restrepo, Marcos I. Rello, Jordi |
author_role |
author |
author2 |
Tejada, Sofia Ferreira-Coimbra, João Restrepo, Marcos I. Rello, Jordi |
author2_role |
author author author author |
dc.contributor.none.fl_str_mv |
Repositório Científico do Centro Hospitalar Universitário de Santo António |
dc.contributor.author.fl_str_mv |
Campogiani, Laura Tejada, Sofia Ferreira-Coimbra, João Restrepo, Marcos I. Rello, Jordi |
dc.subject.por.fl_str_mv |
Clinical practice guidelines GRADE Hospital-acquired pneumonia Quality of evidence Ventilator-associated pneumonia |
topic |
Clinical practice guidelines GRADE Hospital-acquired pneumonia Quality of evidence Ventilator-associated pneumonia |
description |
Clinical practice guidelines (CPGs) are intended to support clinical decisions and should be based on high-quality evidence. The objective of the study was to evaluate the quality of evidence supporting the recommendations issued in CPGs for therapy, diagnosis, and prevention of hospital-acquired and ventilator-associated pneumonia (HAP/VAP). CPGs released by international scientific societies after year 2000, using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology, were analyzed. Number and strength of recommendations and quality of evidence (high, moderate, low, and very low) were extracted and indexed in the aforementioned sections. High-quality evidence was based on randomized control trials (RCT) without important limitations and exceptionally on rigorous observational studies. Eighty recommendations were assessed, with 7 (8.7%), 24 (30.0%), 29 (36.3%), and 20 (25.0%) being supported by high, moderate, low, and very low-quality evidence, respectively. Highest evidence degree was reported for 26 prevention recommendations, with 7 (26.9%) supported by high-quality evidence and no recommendation based on very low-quality evidence. In contrast, among 9 recommendations for diagnosis and 45 for therapy, none was supported by high-quality evidence, in spite of being recommended as strong in 33.3% and 46.7%, respectively. Among HAP/VAP diagnosis recommendations, the majority of evidence was rated as low or very low-quality (55.6% and 22.2%, respectively) whereas among HAP/VAP therapy recommendations, 4/5 were rated as low and very low-quality (40% each). In conclusion, among HAP/VAP international guidelines, most recommendations, particularly in therapy, remain supported by observational studies, case reports, and expert opinion. Well-designed RCTs are urgently needed. |
publishDate |
2019 |
dc.date.none.fl_str_mv |
2019 2019-01-01T00:00:00Z 2021-11-22T15:44:36Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.16/2601 |
url |
http://hdl.handle.net/10400.16/2601 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Campogiani L, Tejada S, Ferreira-Coimbra J, Restrepo MI, Rello J. Evidence supporting recommendations from international guidelines on treatment, diagnosis, and prevention of HAP and VAP in adults. Eur J Clin Microbiol Infect Dis. 2020;39(3):483-491. doi:10.1007/s10096-019-03748-z 0934-9723 10.1007/s10096-019-03748-z |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Springer |
publisher.none.fl_str_mv |
Springer |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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