Incorporating Antimicrobial Resistance Considerations in Antimicrobial Evidence-Based Practice Guidelines: A Protocol for the Development of a Checklist and Multifaceted Appraisal of Existing Guidelines

Abstract

Introduction

Antimicrobial resistance (AMR) is a widely recognized threat to global health, mainly driven by the inappropriate use of antimicrobials. Recommendations from evidence-based practice guidelines (EBPGs) can promote appropriate antimicrobial use. Currently, no guidance exists for considering AMR in EBPGs. This is the protocol for two studies that aim to (1) develop a checklist of AMR considerations for EBPGs and (2) conduct a case study to evaluate existing EBPGs regarding the extent to which AMR is considered among other methodological assessments.

Methods

Using the Delphi technique, we will consult with individuals from four interest-holder groups to develop and refine a checklist of AMR considerations for EBPGs. To assess EBPGs, we will search various databases for guidelines on four prioritized syndromes (i.e., community-acquired pneumonia, urinary tract infection, skin and soft tissue infections and exacerbations of chronic obstructive pulmonary disease). We will screen articles in duplicate and in stages to include EBPGs for the prioritized syndromes and will use piloted data extraction forms to extract characteristics of the EBPGs. For each EBPG, we will evaluate whether AMR was considered (using the developed checklist), its trustworthiness (i.e., methodological quality) (using the modified National Guideline Clearinghouse Extent of Adherence to Trustworthy Standards instrument) and its adaptability (using items from existing adaptability frameworks).

Discussion

This work will develop a checklist of AMR considerations for EBPGs and evaluate a subsequent sample of EBPGs to investigate the extent to which AMR is considered. Furthermore, by conducting a methodological appraisal of trustworthiness and adaptability, this study will contextualize results to promote the uptake and appropriate interpretation of existing guidelines. Thus, these findings will be useful to decision-makers as well as guideline development groups as they highlight what existing work can be trusted and leveraged while also identifying what limitations and gaps need to be addressed.