Conflicts of interest in infection prevention and control research: no smoke without fire. A narrative review

Abstract

Conflicts of interest (COIs) do occur in healthcare research, yet their impact on research in the field of infection prevention and control (IPC) is unknown. We conducted a narrative review aiming to identify examples of COIs in IPC research. In addition to well-known instances, we conducted PubMed and Google searches to identify and report case studies of COIs in IPC and antimicrobial resistance (AMR), which were chosen arbitrarily following consensus meetings, to illustrate different types of COIs. We also searched the Retraction Watch database and blog to systematically identify retracted IPC and/or infectious disease-related papers. Our review highlights COIs in academic research linked to ties between industry and physicians, journal editors, peer-reviewed journals' choice for publication, and guideline committees participants and authors. It explores how COIs can affect research and could be managed. We also present several selected case studies that involve (1) the chlorhexidine industry and how it has used marketing trials and key opinion leaders to promote off-label use of its products; (2) the copper industry and how reporting of its trials in IPC have furthered their agenda; (3) the influence of a company developing "closed infusion systems" for catheters and how this affects networks in low- and middle-income countries and guideline development; (4) potential perverse incentives hospitals may have in reporting healthcare-associated infection or AMR rates and how government intervention may restrict AMR research for fear of bad publicity and subsequent negative economic consequences. Finally, the analysis of reasons for the retraction of previously published papers highlights the fact that misconduct in research may have other motivations than financial gain, the most visible form of COIs. COIs occur in the field of research in general, and IPC and AMR are no exceptions. Their effects pervade all aspects of the research and publication processes. We believe that, in addition to improvements in management strategies of COIs, increased public funding should be available to decrease researchers' dependency on industry ties. Further research is needed on COIs and their management.

Recommendations on Off-Label Drug Use in Pediatric Guidelines

“…On the other hand, off-label drugs that are not on the list and recommendations that are not supported by the evidence should be noticed and considered, such as infliximab for psoriasis ( Menter et al, 2020 ), which might have a possible conflict of interest. According to our analysis, more than 10% of off-label drug guidelines involve possible commercial promotion, consistent with the current situation ( Abbas et al, 2018 ).…”

Infection prevention requirements for the medical care of immunosuppressed patients: recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute

“…2 with no statistical data) [ 123 ]. This study is also the focus of criticism because of a possible conflict of interests [ 124 ]. In the full body “wash” patient group, the incidence density of intravascular catheter-related infections caused by coagulase-negative staphylococci (CoNS), in particular, was reduced; this can also be achieved through consistent use of prevention bundles [ 65 ], [ 66 ], [ 67 ], [ 120 ].…”

Focus on ethics of admission and discharge policies and conflicts of interest

“…In a narrative review on COIs in infection prevention and control research, Abbas et al demonstrated the all-pervasiveness of COIs, highlighting not only the relationship between industry and physicians, but also those with journal editors, guideline committee participants, and authors. They described the potentially devastating consequences of institutional COIs when these are torn between the need to report infection rates and the need to maintain a good public image, and the risk that COIs may distance guidelines from implementable practice [11].…”