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Levels of evidence supporting clinical practice guidelines on invasive aspergillosis

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Abstract

Invasive aspergillosis (IA) is a severe life-threatening infection with challenges in therapy. The aim was to evaluate the level of evidence (LOE) supporting recommendations in clinical practice guidelines (CPGs) of IA and changes over time. Search on CPG on IA released between 2000 and 2019 was done. Last versions were evaluated and compared with previous versions. Recommendations were classified by LOE as A (multiple randomized controlled trial (RCT) or meta-analysis), B (data from a single RCT or observational studies), or C (observational studies with limitations, case series, or expert opinion). Diagnosis recommendations were excluded. Five CPG from three groups of scientific societies were identified: the 2016 Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS), 2017 European Society of Clinical Microbiology Infectious Diseases/European Confederation of Medical Mycology/European Respiratory Society (ESCMID/ECMM/ERS), 2018 Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) CPGs, and their previous versions (2008 IDSA/ATS and 2011 GEMICOMED/SEIMC). ECMID/ECMM/ERS have not published any previous version. From 511 recommendations analyzed, 80 were classified as LOE A (15.7%), 223 LOE B (43.6%), and 208 LOE C (40.7%). Among 238 strong recommendations, only 57 (24.0%) were supported by LOE A. When comparing recent CPGs with previous versions, the proportion of recommendations supported by LOE A did not significantly increase over time (IDSA/ATS: 13.3% [2016] vs. 14.8% [2008], p = 0.798; and SEIMC: 22.6% [2018] vs. 19% [2011], p = 0.568). In conclusion, IA is a condition with an urgent unmet clinical need for more high-quality randomized trials.

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Abbreviations

ACC:

American College of Cardiology

AHA:

American Heart Association

ATS:

American Thoracic Society

CPG:

Clinical Practice Guidelines

ECIL:

European Conference on Infections and Leukemia

ECMM:

European Confederation of Medical Mycology

ERS:

European Respiratory Society

ESCMID:

European Society of Clinical Microbiology and Infectious Diseases

GEMICOMED:

Grupo de Estudio de Micología Médica

IA:

Invasive Aspergillosis

IDSA:

Infectious Diseases Society of America

IPA:

Invasive Pulmonary Aspergillosis

LOE:

Level of Evidence

MA:

Meta-analysis

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-analyses

RCT:

Randomized Controlled Trial

SEIMC:

Spanish Society of Infectious Diseases and Clinical Microbiology

SR:

Systematic Review

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Acknowledgments

Authors appreciate comments from Maria Teresa Martin, Microbiology Department, Vall d’Hebron University Hospital who helped to improve the final manuscript.

Funding

This work was funded in part by CIBERES, Instituto Salud Carlos III, Madrid, Spain (Fondos FEDER) (CB06–06-036). Dr. Blot holds a research mandate of the Special Research Fund at Ghent University.

Author information

Authors and Affiliations

  1. CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Barcelona, Spain

    Sofía Tejada & Jordi Rello

  2. Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), - Vall d‘Hebron Institut de Recerca, Barcelona, Spain

    Sofía Tejada & Jordi Rello

  3. Clinical Infectious Diseases, Department of System Medicine, Tor Vergata University, Rome, Italy

    Laura Campogiani

  4. Internal Medicine Department, Centro Hospitalar Universitario do Porto, Porto, Portugal

    João Ferreira-Coimbra

  5. Department of Internal Medicine & Pediatrics, Ghent University, Ghent, Belgium

    Stijn Blot

  6. Burns, Trauma & Critical Care Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia

    Stijn Blot

  7. Clinical Research in the ICU, Anesthesia Department, CHU Nimes, Universite de Nimes-Montpellier, Montpellier, France

    Jordi Rello

Authors
  1. Sofía Tejada
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  2. Laura Campogiani
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  3. João Ferreira-Coimbra
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  4. Stijn Blot
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  5. Jordi Rello
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Contributions

JR and ST designed the study. The recommendations were abstracted by a single reviewer (ST) and validated by two other reviewers (LC and JFC). ST analyzed data and writes the first manuscript draft. SJB provided statistical analyses and write methods. All authors approved the final version of the manuscript. ST takes full responsibility for the integrity of reported data.

Corresponding author

Correspondence to Sofía Tejada.

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Competing interests

Dr. Rello has served as consultant and in the speakers’ bureau for Pfizer and Astellas. Dr. Blot received research grants from Pfizer. The remaining authors have no conflicts of interest to declare.

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Tejada, S., Campogiani, L., Ferreira-Coimbra, J. et al. Levels of evidence supporting clinical practice guidelines on invasive aspergillosis. Eur J Clin Microbiol Infect Dis 39, 903–913 (2020). https://doi.org/10.1007/s10096-019-03794-7

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  • DOI: https://doi.org/10.1007/s10096-019-03794-7

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