Evaluating Evidence and Grading Recommendations: The SIS/IDSA Guidelines for the Treatment of Complicated Intra-Abdominal Infections

Background: Guidelines for the management and treatment of complicated intra-abdominal infections have been generated by a joint effort of the Surgical Infection Society and the Infectious Diseases Society of America. Continued review is needed of the process of these guideline development efforts, the evidence collected, and the recommendations developed by this collaboration. Methods: The literature employed in the development of these guidelines and the process for the development of the recommendations was reviewed. Results: The process for the development of the guidelines required providing answers to questions surrounding the type of evidence, the quality of that evidence, and whether the data used were generated from clinical trials with investigators blinded to the randomization scheme. The recommendations most commonly follow randomized comparative trials, with observational reports and expert opinions assuming a lesser role. Sources of bias and conflict of interest considerations also must be important in guideline development, with full disclosure from participants. Conclusions: Standards for the evaluation of data and recommendations in the guidelines for complicated intra-abdominal infection provided a rigorous evaluation of available clinical information. This process serves as a model for the development of additional guidelines for patient care.