Evaluation of the current guidelines for antibacterial therapy strategies in patients with cirrhosis or liver failure

BMC Infectious Diseases

Lei Shi¹  Gezhi Zheng¹  Mengmeng Teng²  Tao Zhang²  Ruiying Han²  Ying Zhang²  Dan Sun²  Yalin Dong²  Taotao Wang²  Qian Du²  Yuzhu Dong³  Yan Wang⁴ 

[1] Department of Infections, The First Affiliated Hospital of Xi’an Jiaotong University, 710061, Xi’an, China;Department of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, 710061, Xi’an, China;Department of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, 710061, Xi’an, China;Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, 401120, Chongqing, China;Department of Pharmacy, The Second Affiliated Hospital of Xi’an Jiaotong University, 710061, Xi’an, China;

关键词: Cirrhosis;    Liver failure;    Clinical practice guideline;    Bacterial infections;    AGREE II;   

DOI  :  10.1186/s12879-021-07018-2

来源: Springer

【 摘 要 】

BackgroundBacterial infections are common complications in patients with cirrhosis or liver failure and are correlated with high mortality. Clinical practice guideline (CPG) is a reference used to help clinicians make decisions. This systematic appraisal aimed to evaluate the methodological quality and summarize the recommendations of reported CPGs in these patients.MethodsWe systematically searched CPGs published from 2008 to 2019. The methodological quality of the included CPGs was assessed using the AGREE II instrument. We extracted and compared recommendations for prophylactic and empirical treatment strategies.ResultsFourteen CPGs with a median overall score of 56.3% were included. The highest domain score was Clarity of Presentation (domain 4, 85.4%), and the lowest was for Stakeholder Involvement (domain 2, 31.3%). Three CPGs had an overall score above 80%, and 6 CPGs had a score above 90% in domain 4. Prophylaxis should be strictly limited to patients with varicose bleeding, low ascites protein levels and a history of spontaneous bacterial peritonitis. Fluoroquinolones (norfloxacin and ciprofloxacin), third-generation cephalosporins (G3) (ceftriaxone and cefotaxime) and trimethoprim–sulfamethoxazole (SXT) are recommended for preventing infections in patients with cirrhosis or liver failure. G3, β-lactam/β-lactamase inhibitor combinations (BLBLIs) and carbapenems are recommended as the first choice in empirical treatment according to local epidemiology of bacterial resistance.ConclusionsThe methodological quality of CPGs focused on patients with cirrhosis or liver failure evaluated by the AGREE II instrument is generally poor. Three CPGs that were considered applicable without modification and 6 CPGs that scored above 90% in domain 4 should also be paid more attention to by healthcare practitioners. Regarding recommendations, norfloxacin, ciprofloxacin, ceftriaxone, cefotaxime, and SXT are recommended for prophylactic treatment appropriately. G3, BLBLIs, and carbapenems are recommended for use in empirical treatment strategies.

【 授权许可】

CC BY