Background: Antibiotic resistance requires continuous monitoring by experts to decide whether empiric antibiotic therapies (EAT) should be replaced by alternative antibiotics. The exact moment and criteria for this change is unclear and generally based on consensus between experts. Objectives: This scoping review aims to identify from the literature the resistance thresholds used for a change in EAT and the criteria that they are based upon. Methods: Scoping review for which a comprehensive structured literature search was conducted. Rayyan, software for systematic reviews, was used for the screening of abstracts and titles. Data sources: Pubmed and hand-searching of reference lists and grey literature. Eligibility: Papers concerning any type of bacterial infectious disease and mentioning or defining antibiotic resistance thresholds for decision making purposes for EAT were included. The inclusion and analysis of articles was done by two researchers, any conflicts were resolved through discussion or by consulting a third reviewer. Results: We identified 3146 unique papers. Following title-abstract screening, 125 papers were comprehensively read, 16 papers included. The included papers gave thresholds for urinary tract infections, respiratory tract infections, meningitis, skin and soft tissue infections, gonorrhoea and bone and joint infections. Six criteria were found that were commonly used to base the thresholds on. These were: disease severity, efficacy of treatment, adverse drug events, risk of C. difficile infection, costs and increased resistance. The number of criteria used to define each threshold varied from 1 up to 6 criteria between papers. Conclusions: The thresholds used for EATs are few, commonly based on expert opinion estimates and therefore can have broad ranges. Used criteria underlying reported thresholds are heterogenous and require standardization. Considering the rising trend in resistance there is a clear need for rigid tools to determine thresholds in order to support guideline development with the best and timely evidence.
What is the evidence base of used aggregated antibiotic resistance percentages to change empiric antibiotic treatment? A scoping review
Tacconelli, Evelina;
2022-01-01
Abstract
Background: Antibiotic resistance requires continuous monitoring by experts to decide whether empiric antibiotic therapies (EAT) should be replaced by alternative antibiotics. The exact moment and criteria for this change is unclear and generally based on consensus between experts. Objectives: This scoping review aims to identify from the literature the resistance thresholds used for a change in EAT and the criteria that they are based upon. Methods: Scoping review for which a comprehensive structured literature search was conducted. Rayyan, software for systematic reviews, was used for the screening of abstracts and titles. Data sources: Pubmed and hand-searching of reference lists and grey literature. Eligibility: Papers concerning any type of bacterial infectious disease and mentioning or defining antibiotic resistance thresholds for decision making purposes for EAT were included. The inclusion and analysis of articles was done by two researchers, any conflicts were resolved through discussion or by consulting a third reviewer. Results: We identified 3146 unique papers. Following title-abstract screening, 125 papers were comprehensively read, 16 papers included. The included papers gave thresholds for urinary tract infections, respiratory tract infections, meningitis, skin and soft tissue infections, gonorrhoea and bone and joint infections. Six criteria were found that were commonly used to base the thresholds on. These were: disease severity, efficacy of treatment, adverse drug events, risk of C. difficile infection, costs and increased resistance. The number of criteria used to define each threshold varied from 1 up to 6 criteria between papers. Conclusions: The thresholds used for EATs are few, commonly based on expert opinion estimates and therefore can have broad ranges. Used criteria underlying reported thresholds are heterogenous and require standardization. Considering the rising trend in resistance there is a clear need for rigid tools to determine thresholds in order to support guideline development with the best and timely evidence.
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