Systematic review and evidence- based guidance ... - ECDC - Europa

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TECHNICAL REPORTSystematic review and evidence-based guidance on perioperative antibiotic prophylaxisContentsAbbreviations ................................................................................................................................................ vGlossary ....................................................................................................................................................... viExecutive summary ........................................................................................................................................ 11 Introduction ............................................................................................................................................... 32 Methodology ............................................................................................................................................... 42.1 Systematic review ............................................................................................................................... 42.1.1 Objectives .................................................................................................................................. 42.1.2 Inclusion/exclusion criteria ........................................................................................................... 42.1.3 Defining the population, intervention, comparison and outcome (PICO) for each question/objective ... 52.1.4 Search strategy and study selection .............................................................................................. 72.1.5 Study selection from results of systematic review ........................................................................... 72.1.6 Quality assessment of included studies .......................................................................................... 72.2 Key PAP modalities: indicators and barriers to implementation .............................................................. 102.2.1 First expert meeting .................................................................................................................. 102.2.2 Second expert meeting .............................................................................................................. 102.2.3 Third expert meeting ................................................................................................................. 103 Results ..................................................................................................................................................... 123.1 Results of the systematic review ......................................................................................................... 123.1.1 Search strategy ......................................................................................................................... 123.2 Results of the expert meetings ........................................................................................................... 273.2.1 First expert meeting, Berlin, Germany ......................................................................................... 273.2.2 Second expert meeting, Berlin, Germany ..................................................................................... 283.2.3 Third expert meeting, Stockholm, Sweden ................................................................................... 314 Guidance on five key PAP modalities and corresponding indicators ................................................................ 334.1 Multidisciplinary antimicrobial management teams ............................................................................... 334.2 Responsibility for appropriate timing of perioperative antibiotic prophylaxis ............................................ 334.3 Timing of perioperative antibiotic prophylaxis ...................................................................................... 344.4 Dosing and duration of perioperative antibiotic prophylaxis ................................................................... 344.5 Duration and termination of perioperative antibiotic prophylaxis ............................................................ 345 Limitations................................................................................................................................................ 356 Conclusions .............................................................................................................................................. 367 References ............................................................................................................................................... 37Annex 1. Table of the search strategies ......................................................................................................... 44Annex 2. Excluded studies ............................................................................................................................ 46iii
Systematic review and evidence-based guidance on perioperative antibiotic prophylaxisTECHNICAL REPORTFiguresFigure 1. Flowchart: developing five key modalities for PAP ............................................................................. 10Figure 2. PRISMA flowchart: identified, screened, and included/excluded studies ............................................... 12Figure 3. Expert grading of the proposed PAP modalities ................................................................................. 27Figure 4. Summary of the experts’ recommendation to proposed PAP modalities ............................................... 28TablesTable 1. Limitations in study design suggesting a high likelihood of bias ............................................................. 8Table 2. Equivalency levels of Ranji et al.’s grades to the grades assigned by the GRADE approach [22-25] ........... 9Table 3. Distribution of included study designs and geographical location of studies, by continent ....................... 12Table 4. Distribution of included study design and geographical location of included studies, Objective 1 ............. 13Table 5. Distribution of included study design and geographical location of included studies, Objective 2 ............. 16Table 6. Distribution of included study design and geographical location of included studies, Objective 3 ............. 18Table 7. Distribution of included study design and geographical location of included studies, Objective 4 ............. 19Table 8. Distribution of included study design and geographical location of included studies, Objective 5 ............. 22Table 9. Studies supporting Modality 1 and quality of evidence ........................................................................ 23Table 10. Studies supporting Modality 2 and quality of evidence ...................................................................... 23Table 11. Studies supporting Modality 3 and quality of evidence ...................................................................... 24Table 12. Studies supporting Modality 4 and quality of evidence ...................................................................... 24Table 13. Studies supporting Modality 5 and quality of evidence ...................................................................... 25Table 14. Studies supporting Modality 6 and quality of evidence ...................................................................... 25Table 15. Studies supporting Modality 7 and quality of evidence ...................................................................... 25Table 16. Studies supporting Modality 8 and quality of evidence ...................................................................... 26Table 17. Studies supporting Modality 9 and quality of evidence ...................................................................... 26Table 18. Studies supporting Modality 10 and quality of evidence ..................................................................... 27Table 19. PAP modalities as outlined at the first expert meeting ....................................................................... 28Table 20. Results of the experts’ re-scoring by email of 10 PAP modalities prior to the second expert meeting ..... 29Table 21. Final five key modalities for perioperative antibiotic prophylaxis ......................................................... 31Table 22. Final five key PAP modalities and corresponding indicators ................................................................ 31Table 23. Experts’ consensus for each proposed barrier ................................................................................... 32Table 24. Checklist for Indicator 1 ................................................................................................................. 33Tables in AnnexesTable 1.1. Search strategy of MEDLINE via PubMed for Objectives 1, 2 and 3.................................................... 44Table 1.2. Search of MEDLINE/Embase via OVID for Objectives 1, 2 and 3 ....................................................... 44Table 1.3. Search of MEDLINE via PubMed for Objective 4 ............................................................................... 44Table 1.4. Search of MEDLINE via PubMed for Objective 5 ............................................................................... 45Table 1.5. Search of MEDLINE via PubMed for Objective 5 ............................................................................... 45Table 1.6. Search of MEDLINE/Embase via OVID for Objective 5 ...................................................................... 45Table 2.1. Excluded studies .......................................................................................................................... 46iv
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