MDedge
Appendix 1. Analysis of evidence-based national guidelines relevant to each of the three clinical vignettes.Dyspnea ScenarioGuidelineBaseline ScenarioMedical Comorbidity Poor Functional Status Age >85 Limited Follow-UpMandell et al. IDSA/ATS Guidelines. 2005PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYW5kZWxsPC9BdXRob3I+PFllYXI+MjAwNzwvWWVhcj48
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0300-2977 (Linking)</isbn><accession-num>16186645</accession-num><urls><related-urls><url> AddressedNot AddressedNot AddressedNot AddressedWoodhead et al. Guidelines for LRTI. 2011 ADDIN EN.CITE <EndNote><Cite><Author>Woodhead</Author><Year>2011</Year><RecNum>1091</RecNum><record><rec-number>1091</rec-number><foreign-keys><key app="EN" db-id="9p2p5rteratvp8efs26p95tftrtevrx90fa0">1091</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Woodhead, M.</author><author>Blasi, F.</author><author>Ewig, S.</author><author>Garau, J.</author><author>Huchon, G.</author><author>Ieven, M.</author><author>Ortqvist, A.</author><author>Schaberg, T.</author><author>Torres, A.</author><author>van der Heijden, G.</author><author>Read, R.</author><author>Verheij, T. J.</author></authors></contributors><auth-address>Department of Respiratory Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, UK. mark.woodhead@cmft.nhs.uk</auth-address><titles><title>Guidelines for the management of adult lower respiratory tract infections--summary</title><secondary-title>Clin Microbiol Infect</secondary-title></titles><pages>1-24</pages><volume>17 Suppl 6</volume><edition>2011/11/02</edition><keywords><keyword>Adult</keyword><keyword>Bronchiectasis/drug therapy</keyword><keyword>Community-Acquired Infections/*drug therapy</keyword><keyword>Cross Infection/*drug therapy</keyword><keyword>Disease Management</keyword><keyword>Evidence-Based Medicine</keyword><keyword>Humans</keyword><keyword>Pneumonia/drug therapy</keyword><keyword>Pulmonary Disease, Chronic Obstructive/drug therapy</keyword><keyword>Respiratory Tract Infections/*drug therapy</keyword></keywords><dates><year>2011</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1469-0691 (Electronic)
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ADDIN EN.CITE.DATA 30AddressedNot AddressedNot AddressedNot AddressedNot AddressedMay et al. Surgical Infection Society Guidelines. 2011 ADDIN EN.CITE <EndNote><Cite><Author>May</Author><Year>2011</Year><RecNum>1181</RecNum><record><rec-number>1181</rec-number><foreign-keys><key app="EN" db-id="9p2p5rteratvp8efs26p95tftrtevrx90fa0">1181</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>May, A. K.</author></authors></contributors><auth-address>Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA. Addison.K.May@vanderbilt.edu</auth-address><titles><title>Skin and soft tissue infections: the new surgical infection society guidelines</title><secondary-title>Surg Infect (Larchmt)</secondary-title></titles><pages>179-84</pages><volume>12</volume><number>3</number><edition>2011/07/20</edition><keywords><keyword>Anti-Bacterial Agents/therapeutic use</keyword><keyword>Community-Acquired Infections/drug therapy/epidemiology/microbiology</keyword><keyword>Cross Infection/*drug therapy/epidemiology/microbiology</keyword><keyword>Early Diagnosis</keyword><keyword>Guidelines as Topic</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Methicillin-Resistant Staphylococcus aureus/isolation & purification</keyword><keyword>Skin Diseases, Infectious/*drug therapy/epidemiology/microbiology</keyword><keyword>Soft Tissue Infections/*drug therapy/epidemiology/microbiology</keyword></keywords><dates><year>2011</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1557-8674 (Electronic)
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ADDIN EN.CITE.DATA 11AddressedNot AddressedNot AddressedNot AddressedNot AddressedAsymptomatic Bacteriuria ScenarioGuidelineBaseline ScenarioMedical Comorbidity Poor Functional Status Age >85 Nicolle et al. IDSA Asymptomatic Bacteriuria Guidelines. 2005 ADDIN EN.CITE <EndNote><Cite><Author>Nicolle</Author><Year>2005</Year><RecNum>1039</RecNum><record><rec-number>1039</rec-number><foreign-keys><key app="EN" db-id="9p2p5rteratvp8efs26p95tftrtevrx90fa0">1039</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Nicolle, L. E.</author><author>Bradley, S.</author><author>Colgan, R.</author><author>Rice, J. C.</author><author>Schaeffer, A.</author><author>Hooton, T. M.</author></authors></contributors><auth-address>University of Manitoba, Health Sciences Centre, Winnipeg, Manitoba, Canada. lnicolle@hsc.mb.ca</auth-address><titles><title>Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults</title><secondary-title>Clin Infect Dis</secondary-title></titles><pages>643-54</pages><volume>40</volume><number>5</number><edition>2005/02/17</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>*Aging</keyword><keyword>Anti-Bacterial Agents/*therapeutic use</keyword><keyword>Bacteriuria/*diagnosis/*drug therapy</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Risk Factors</keyword><keyword>Spinal Cord Injuries</keyword><keyword>Urinary Catheterization</keyword></keywords><dates><year>2005</year><pub-dates><date>Mar 1</date></pub-dates></dates><isbn>1537-6591 (Electronic)
1058-4838 (Linking)</isbn><accession-num>15714408</accession-num><urls><related-urls><url> [pii]
10.1086/427507</electronic-resource-num><language>eng</language></record></Cite></EndNote>31AddressedAddressedAddressed*AddressedHooton et al. IDSA CAUTI Guidelines. 2009 ADDIN EN.CITE <EndNote><Cite><Author>Hooton</Author><Year>2010</Year><RecNum>1193</RecNum><record><rec-number>1193</rec-number><foreign-keys><key app="EN" db-id="9p2p5rteratvp8efs26p95tftrtevrx90fa0">1193</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hooton, T. M.</author><author>Bradley, S. F.</author><author>Cardenas, D. D.</author><author>Colgan, R.</author><author>Geerlings, S. E.</author><author>Rice, J. C.</author><author>Saint, S.</author><author>Schaeffer, A. J.</author><author>Tambayh, P. A.</author><author>Tenke, P.</author><author>Nicolle, L. E.</author></authors></contributors><auth-address>Department of Medicine, University of Miami, Florida 33136, USA. thooton@med.miami.edu</auth-address><titles><title>Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America</title><secondary-title>Clin Infect Dis</secondary-title></titles><pages>625-63</pages><volume>50</volume><number>5</number><edition>2010/02/23</edition><keywords><keyword>Adult</keyword><keyword>Catheter-Related Infections/*diagnosis/prevention & control/*therapy</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Urinary Tract Infections/*diagnosis/prevention & control/*therapy</keyword></keywords><dates><year>2010</year><pub-dates><date>Mar 1</date></pub-dates></dates><isbn>1537-6591 (Electronic)
1058-4838 (Linking)</isbn><accession-num>20175247</accession-num><urls><related-urls><url>*Addressed*Not AddressedDubeau et al. European Urinary Incontinence Guidelines. 2009 ADDIN EN.CITE <EndNote><Cite><Author>DuBeau</Author><Year>2009</Year><RecNum>1236</RecNum><record><rec-number>1236</rec-number><foreign-keys><key app="EN" db-id="9p2p5rteratvp8efs26p95tftrtevrx90fa0">1236</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="normal" font="Helvetica" size="12">C. E. DuBeau</style></author></authors></contributors><titles><title><style face="normal" font="Helvetica" size="12">Incontinence in the Frail Elderly</style></title></titles><pages><style face="normal" font="Helvetica" size="12">961-1024</style></pages><volume><style face="normal" font="Helvetica" size="12">11</style></volume><section><style face="normal" font="Helvetica" size="12">961</style></section><dates><year><style face="normal" font="Helvetica" size="12">2009</style></year></dates><urls></urls></record></Cite></EndNote>71Not AddressedNot AddressedAddressed*AddressedGrabe et al. European Association of Urology UTI Guidelines. 2010 ADDIN EN.CITE <EndNote><Cite><Author>Grabe</Author><Year>2010</Year><RecNum>1194</RecNum><record><rec-number>1194</rec-number><foreign-keys><key app="EN" db-id="9p2p5rteratvp8efs26p95tftrtevrx90fa0">1194</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="normal" font="Helvetica" size="12">M. Grabe</style></author></authors></contributors><titles><title><style face="normal" font="Helvetica" size="12">Guidelines on Urological Infections</style></title><secondary-title><style face="normal" font="Helvetica" size="12">European Association of Urology</style></secondary-title></titles><pages><style face="normal" font="Helvetica" size="12">1-112</style></pages><dates><year><style face="normal" font="Helvetica" size="12">2010</style></year></dates><urls></urls></record></Cite></EndNote>55AddressedAddressedAddressed*AddressedSIGN. Scottish UTI Guidelines.2012 ADDIN EN.CITE <EndNote><Cite><Author>(SIGN)</Author><Year>2012</Year><RecNum>1234</RecNum><record><rec-number>1234</rec-number><foreign-keys><key app="EN" db-id="9p2p5rteratvp8efs26p95tftrtevrx90fa0">1234</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="normal" font="Helvetica" size="12">Scottish Intercollegiate Guidelines Network (SIGN)</style></author></authors></contributors><titles><title><style face="normal" font="Helvetica" size="12">Management of suspected bacterial urinary tract infection in adults.</style></title><secondary-title><style face="normal" font="Helvetica" size="12">SIGN</style></secondary-title></titles><volume><style face="normal" font="Helvetica" size="12">88</style></volume><dates><year><style face="normal" font="Helvetica" size="12">2012</style></year></dates><urls></urls></record></Cite></EndNote>56AddressedAddressedAddressed*AddressedGeerlings et al. Dutch UTI Guidelines. 2013 ADDIN EN.CITE <EndNote><Cite><Author>Geerlings</Author><Year>2013</Year><RecNum>1195</RecNum><record><rec-number>1195</rec-number><foreign-keys><key app="EN" db-id="9p2p5rteratvp8efs26p95tftrtevrx90fa0">1195</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="normal" font="Helvetica" size="12">S.E. Geerlings</style></author></authors></contributors><titles><title><style face="normal" font="Helvetica" size="12">Guidelines for Antimicrobial Therapy of Complicated Urinary Tract Infections in Adults</style></title><secondary-title><style face="normal" font="Helvetica" size="12">Dutch Working Party on Antibiotic Policy</style></secondary-title></titles><pages><style face="normal" font="Helvetica" size="12">1-94</style></pages><dates><year><style face="normal" font="Helvetica" size="12">2013</style></year></dates><urls></urls></record></Cite></EndNote>57AddressedAddressedNot AddressedNot AddressedAppendix 1 Legend. Appendix 1 lists the 20 evidence-based national guidelines relevant to the three clinical vignettes that were reviewed (10 guidelines for the dyspnea case, 4 guidelines for the skin infection case, 6 guidelines for the asymptomatic bacteriuria case). We performed a systematic search of clinical practice guidelines from PubMed (), the Agency for Healthcare Research and Quality National Guideline Clearinghouse (), and the Infectious Diseases Society of American (IDSA) practice guidelines database (), on April 17, 2014 using keywords relevant to the three clinical vignettes (“community-acquired pneumonia,” “lower respiratory tract infection,” “abscess,” “skin and soft tissue infection,” “bacteriuria,” “urinary tract infection,” and “antibiotic stewardship”). Documents not published in peer-reviewed journals were excluded from the analysis. Relevant guidelines were reviewed in detail to assess whether recommendations for antibiotic management were addressed, including recommendations for patients with the following medical complexities: medical comorbidities, poor functional status, older age, and limited follow-up after hospital discharge. Guidelines were coded “Addressed” if they gave recommendations for antibiotic management specific to the clinical scenario for the baseline vignette and the modified vignettes, each with one of four medical complexities (medical comorbidities, poor functional status, older age greater than 85, and poor follow-up). Guidelines were coded at “Not Addressed” if they did not mention antibiotic management relevant to the clinical vignette. Guidelines coded as “Addressed*” gave specific antibiotic management recommendations for patients with medical complexities different from those that were described in the survey. ADDIN EN.REFLIST 1.Doos L, Bradley E, Rushton CA, Satchithananda D, Davies SJ, Kadam UT. Heart failure and chronic obstructive pulmonary disease multimorbidity at hospital discharge transition: a study of patient and carer experience. Health Expect. May 16 2014.2.Bernabeu-Wittel M, Alonso-Coello P, Rico-Blazquez M, Rotaeche Del Campo R, Sanchez Gomez S, Casariego Vales E. [Development of clinical practice guidelines for patients with comorbidity and multiple diseases]. Aten Primaria. Aug-Sep 2014;46(7):385-392.3.Corrales-Medina VF, Suh KN, Rose G, et al. Cardiac complications in patients with community-acquired pneumonia: a systematic review and meta-analysis of observational studies. PLoS Med. Jun 2011;8(6):e1001048.4.Goss CH, Rubenfeld GD, Park DR, Sherbin VL, Goodman MS, Root RK. Cost and incidence of social comorbidities in low-risk patients with community-acquired pneumonia admitted to a public hospital. Chest. Dec 2003;124(6):2148-2155.5.Jenkinson CE, Winder RE, Sugg HV, et al. Why do GPs exclude patients from participating in research? An exploration of adherence to and divergence from trial criteria. Fam Pract. Jun 2014;31(3):364-370.6.Thomsen RW, Kasatpibal N, Riis A, Norgaard M, Sorensen HT. The impact of pre-existing heart failure on pneumonia prognosis: population-based cohort study. J Gen Intern Med. Sep 2008;23(9):1407-1413.7.Angus DC, Marrie TJ, Obrosky DS, et al. Severe community-acquired pneumonia: use of intensive care services and evaluation of American and British Thoracic Society Diagnostic criteria. Am J Respir Crit Care Med. Sep 1 2002;166(5):717-723.8.Mandell L. Decisions about treating community-acquired pneumonia. Ann Intern Med. Feb 1 2005;142(3):215-216.9.Spellberg B, Guidos R, Gilbert D, et al. The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis. Jan 15 2008;46(2):155-164.10.Will antibiotic misuse now stop? Nat Rev Microbiol. Nov 2003;1(2):85.11.Dellit TH, Owens RC, McGowan JE, Jr., et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 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Diagnosis and management of immediate hypersensitivity reactions to cephalosporins. Clin Rev Allergy Immunol. Aug 2013;45(1):131-142.18.Grill MF, Maganti RK. Neurotoxic effects associated with antibiotic use: management considerations. Br J Clin Pharmacol. Sep 2011;72(3):381-393.19.Slama TG, Amin A, Brunton SA, et al. A clinician's guide to the appropriate and accurate use of antibiotics: the Council for Appropriate and Rational Antibiotic Therapy (CARAT) criteria. Am J Med. Jul 2005;118 Suppl 7A:1S-6S.20.Tunger O, Dinc G, Ozbakkaloglu B, Atman UC, Algun U. Evaluation of rational antibiotic use. Int J Antimicrob Agents. Jul 2000;15(2):131-135.21.Kern WV, de With K. [Rational antibiotic prescribing. Challenges and successes]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. Nov 2012;55(11-12):1418-1426.22.Bodi M, Rodriguez A, Sole-Violan J, et al. Antibiotic prescription for community-acquired pneumonia in the intensive care unit: impact of adherence to Infectious Diseases Society of America guidelines on survival. Clin Infect Dis. Dec 15 2005;41(12):1709-1716.23.Wilke M, Grube RF, Bodmann KF. Guideline-adherent initial intravenous antibiotic therapy for hospital-acquired/ventilator-associated pneumonia is clinically superior, saves lives and is cheaper than non guideline adherent therapy. Eur J Med Res. Jul 25 2011;16(7):315-323.24.Pulcini C, Cua E, Lieutier F, Landraud L, Dellamonica P, Roger PM. Antibiotic misuse: a prospective clinical audit in a French university hospital. Eur J Clin Microbiol Infect Dis. Apr 2007;26(4):277-280.25.Hecker MT, Aron DC, Patel NP, Lehmann MK, Donskey CJ. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med. Apr 28 2003;163(8):972-978.26.Kardas P, Devine S, Golembesky A, Roberts C. A systematic review and meta-analysis of misuse of antibiotic therapies in the community. Int J Antimicrob Agents. Aug 2005;26(2):106-113.27.Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care. Lancet. Oct 11 2003;362(9391):1225-1230.28.Kahn KL, MacLean CH, Liu H, et al. The complexity of care for patients with rheumatoid arthritis: metrics for better understanding chronic disease care. Med Care. Jan 2007;45(1):55-65.29.Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. Mar 1 2007;44 Suppl 2:S27-72.30.Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. Jul 15 2014;59(2):e10-52.31.Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. Mar 1 2005;40(5):643-654.32.Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart disease and stroke statistics--2010 update: a report from the American Heart Association. Circulation. Feb 23 2010;121(7):e46-e215.33.Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J. Oct 2008;29(19):2388-2442.34.Collins SP, Lindsell CJ, Storrow AB, Abraham WT. Prevalence of negative chest radiography results in the emergency department patient with decompensated heart failure. Ann Emerg Med. Jan 2006;47(1):13-18.35.Basi SK, Marrie TJ, Huang JQ, Majumdar SR. Patients admitted to hospital with suspected pneumonia and normal chest radiographs: epidemiology, microbiology, and outcomes. Am J Med. Sep 1 2004;117(5):305-311.36.Miller L ED, Liu H, Chun-Lan Chang, et al. Incidence of Skin and Soft tissue Infections in Ambulatory and Inpatient Settings, 2005-2010. BMC Infectious Disease. 2015;Submitted for publication.37.Trautner BW. Asymptomatic bacteriuria: when the treatment is worse than the disease. Nat Rev Urol. Feb 2012;9(2):85-93.38.Geiss LS, Wang J, Cheng YJ, et al. Prevalence and incidence trends for diagnosed diabetes among adults aged 20 to 79 years, United States, 1980-2012. JAMA. Sep 24 2014;312(12):1218-1226.39.Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. Feb 26 2014;311(8):806-814.40.Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. Mar 2 2013;381(9868):752-762.41.Hwang SW, Lebow JM, Bierer MF, O'Connell JJ, Orav EJ, Brennan TA. Risk factors for death in homeless adults in Boston. Arch Intern Med. Jul 13 1998;158(13):1454-1460.42.Singer J. Taking it to the streets: homelessness, health, and health care in the United States. J Gen Intern Med. Nov 2003;18(11):964-965.43.Wester CW, Durairaj L, Evans AT, Schwartz DN, Husain S, Martinez E. Antibiotic resistance: a survey of physician perceptions. Arch Intern Med. Oct 28 2002;162(19):2210-2216.44.Wood F, Phillips C, Brookes-Howell L, et al. Primary care clinicians' perceptions of antibiotic resistance: a multi-country qualitative interview study. J Antimicrob Chemother. Jan 2013;68(1):237-243.45.Mavros MN, Alexiou VG, Vardakas KZ, Tsokali K, Sardi TA, Falagas ME. 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Guidelines on uncomplicated urinary tract infections are difficult to follow: perceived barriers and suggested interventions. BMC Fam Pract. 2010;11:51.50.Lugtenberg M, Zegers-van Schaick JM, Westert GP, Burgers JS. Why don't physicians adhere to guideline recommendations in practice? An analysis of barriers among Dutch general practitioners. Implement Sci. 2009;4:54.51.Lugtenberg M, Burgers JS, Besters CF, Han D, Westert GP. Perceived barriers to guideline adherence: a survey among general practitioners. BMC Fam Pract. 2011;12:98.52.Campbell RR, Beere D, Wilcock GK, Brown EM. Clostridium difficile in acute and long-stay elderly patients. Age Ageing. Sep 1988;17(5):333-336.53.Mizokami F, Shibasaki M, Yoshizue Y, Noro T, Mizuno T, Furuta K. Pharmacodynamics of vancomycin in elderly patients aged 75 years or older with methicillin-resistant Staphylococcus aureus hospital-acquired pneumonia. Clin Interv Aging. 2013;8:1015-1021.54.Hall RG, 2nd, Hazlewood KA, Brouse SD, et al. 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