A quality assessment of evidence-based guidelines for the prevention and management of ventilator-associated pneumonia: a systematic review

Abstract

Background: Numerous evidence-based guidelines (EBGs) pertaining to ventilator-associated pneumonia (VAP) have been published by domestic and international organizations, but their qualities have not been reported. Methods: A systematic search of the literature was performed up to July 2018 for relevant guidelines. Guidelines were eligible for inclusion if they incorporated recommendation statements for prevention and/ or management in adults or children with VAP and were developed on a systematic evidence-based method. Four reviewers evaluated each guideline using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, which comprises 23 items organized into six domains in addition to two overall items. Results: Thirteen EBGs were identified for review. An overall high degree of agreement among reviewers was reached [intra-class correlation coefficient (ICC), 0.885; 95% CI, 0.862-0.905] during their review. The scores (mean, range) for the six AGREE domains were: scope and purpose (61%, 51-74%), stakeholder involvement (36%, 18-68%), rigor of development (41%, 22-59%), clarity and presentation (56%, 47-71%), applicability (38%, 21-59%) and editorial independence (50%, 0-77%). Only two EBGs (15.4%) were rated "recommended" for clinical practice. Approximately 86% of recommendations were based on moderate or low levels of evidence (levels B-D were 46.2%, 19.0%, and 21.2%, respectively). The recommendations for prevention and management of VAP were similar among the different EBGs. Conclusions: The overall quality of the identified EBGs pertaining to VAP was classified as moderate. The management of VAP varied by guideline. More high-quality evidence is needed to improve guideline recommendations.

Determination of Antibiotic Resistance Pattern of Organisms Isolated from Endotracheal Tube Cultures of Patients Admitted to Intensive Care Unit

“…The results of the present study showed that VAP is highly prevalent in ICU patients, and most of the organisms causing pneumonia are gram-negative bacteria, which have very high antibiotic resistance and are resistant to almost most commonly used antibiotics in the ICU. Among these, Acinetobacter, which is highly prevalent, has multidrug resistance, and among the antibiotics studied, only colistin was able to somewhat control the growth of the bacterium and the prevalence of pneumonia caused by this bacterium was high, similar to other studies in the ICUs (5,6). Consistent with the results obtained in the present study, Ahsan et al (2016) also reported that the most prevalent microorganisms isolated from the culture of tracheal secretions were gram-negative bacteria (76.13%), followed by fungal pneumonia (17.04%) and finally gram-positive bacteria (6.81%).…”

“…On the other hand, others also consider the incidence of lung infection within the first 24 hours as VAP (4). This sensitivity to distinguish this pneumonia from other lung infections is because hospital pathogens such as Pseudomonas aeruginosa, Acinetobacter baumannii or methicillin-resistant Staphylococcus aureus are resistant to some or all of the antibiotics, and the resulting infections lead to increased mortality rate in 13-25.5% of patients (5,6). Prolonged length of hospital stay increases the hospital costs (7).…”

Metagenomic Next-Generation Sequencing Improves the Prognosis of Patients with Infectious Diseases on Mechanical Ventilation in the Intensive Care Unit (ICU)

“…3)patients suspected of infectious disease requiring microbiological investigations [2,11]. 2)patient unable to ful ll the required medical follow-up;…”

“…2)patients with mechanical ventilation, the expected mechanical ventilation duration was more than 48 hours [2];…”

Metagenomic Next-Generation Sequencing Improves The Prognosis of Patients With Infectious Diseases on Mechanical Ventilation in The Intensive Care Unit (ICU)

“…In the intensive care unit (ICU), severe pneumonia diagnosis is particularly complex due to the similar clinical symptoms. It generally leads to the dysfunction of other organs and thus carries high mortality [1][2][3]. So it is critical to provide an effective symptomatic treatment early.…”