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Prevention of Clostridium difficile Infection: A Systematic Survey of Clinical Practice Guidelines

Published online by Cambridge University Press:  07 June 2016

Lyubov Lytvyn ,
Dominik Mertz ,
Behnam Sadeghirad ,
Faisal Alaklobi ,
Anna Selva ,
Pablo Alonso-Coello  and
Bradley C. Johnston
Lyubov Lytvyn
Affiliation:
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
Dominik Mertz
Affiliation:
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
Behnam Sadeghirad
Affiliation:
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
Faisal Alaklobi
Affiliation:
Department of Pediatric Infectious Disease, King Saud Medical City, Riyadh, Saudi Arabia
Anna Selva
Affiliation:
Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain CIBER de Epidemiologia y Salud Publica, Barcelona, Spain
Pablo Alonso-Coello
Affiliation:
Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain CIBER de Epidemiologia y Salud Publica, Barcelona, Spain
Bradley C. Johnston*
Affiliation:
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
*
Address correspondence to Bradley C. Johnston, PhD, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay St, Rm 11.9859 West, Toronto, ON, Canada, M5G 0A4 (bradley.johnston@sickkids.ca).
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Abstract

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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 8 , August 2016 , pp. 901 - 908
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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