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Evidence supporting recommendations from international guidelines on treatment, diagnosis, and prevention of HAP and VAP in adults

2019Journal article Open access
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dc.contributor.authorCampogiani, Laura
dc.contributor.authorTejada, Sofia
dc.contributor.authorFerreira-Coimbra, João
dc.contributor.authorRestrepo, Marcos I.
dc.contributor.authorRello, Jordi
dc.date.accessioned2021-11-22T15:44:36Z
dc.date.available2021-11-22T15:44:36Z
dc.date.issued2019
dc.description.abstractClinical 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.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationCampogiani 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-zpt_PT
dc.identifier.doi10.1007/s10096-019-03748-zpt_PT
dc.identifier.issn0934-9723
dc.identifier.issn1435-4373
dc.identifier.urihttp://hdl.handle.net/10400.16/2601
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSpringerpt_PT
dc.relation.publisherversionhttps://link.springer.com/article/10.1007%2Fs10096-019-03748-zpt_PT
dc.subjectClinical practice guidelinespt_PT
dc.subjectGRADEpt_PT
dc.subjectHospital-acquired pneumoniapt_PT
dc.subjectQuality of evidencept_PT
dc.subjectVentilator-associated pneumoniapt_PT
dc.titleEvidence supporting recommendations from international guidelines on treatment, diagnosis, and prevention of HAP and VAP in adultspt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.conferencePlaceGermanypt_PT
oaire.citation.endPage491pt_PT
oaire.citation.issue3pt_PT
oaire.citation.startPage483pt_PT
oaire.citation.titleEuropean Journal of Clinical Microbiology & Infectious Diseasespt_PT
oaire.citation.volume39pt_PT
person.familyNameFerreira Coimbra
person.givenNameJoão
person.identifier.orcid0000-0002-5855-8600
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublicationcc1c9f3b-f81e-4494-a4f1-bbeb560463ba
relation.isAuthorOfPublication.latestForDiscoverycc1c9f3b-f81e-4494-a4f1-bbeb560463ba

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