Perioperative antibiotic prophylaxis in adults - Sistema Nazionale ...

Thirty-four guidelines were identified, 7 were selected and just 2 included as beingrelevant to the issues covered in this guideline:• Mariette C, Alves A, Benoist S, Bretagnol F, Mabrut JY, Slim K. Soinspériopératoires en chirurgie digestive. Recommandations de la Sociétéfrançaise de chirurgie digestive (SFCD1);• Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisorystatement from the National Surgical Infection Prevention ProjectClin.Infect.Dis (2004).Regarding studies, the research strategy yielded 58 meta-analyses, systematic reviewsand reports and 131 RCTs. A selection was then made of those considered morerelevant and the complete texts were requested. Analysis of these texts led to a furtherselection of 36 systematic reviews or RCTs from which data were extracted.The methodological appraisement and extraction of data in each review or RCT wereperformed with the support of the methodological checklist of the National Institutefor Health and Clinical Excellence (NICE).Level of evidence and grades of recommendationsThe summary tables for each type of study were compiled on the basis of theevidence described in the studies examined. The tables used by NICE were used, withappropriate adaptations.Levels of evidence and grades of recommendations were assigned following thegrading method described in the SNLG29 methodological manual, which envisages 6levels of evidence (I-VI) and 5 grades of recommendation (A-E).Levels of evidence were assigned on the basis of a study’s design and methodologicalassessment; recommendations were graded in consideration of both the strength ofthe evidence base and the clinical value of the actual recommendations. Theseelements were discussed and agreed by the panel.In the current hierarchy of evidence, expert opinion is not rated very highly, but assomething to which recourse is made when experimental evidence is lacking or in