Guidelines on Prevention and Management of Infection – Report on the Consensus Meeting
Hannah Gordon, GuiCom Member
On Sunday October 11, 2020, all participants of the ECCO Guidelines on Prevention and Management of Infection met with the aim of reaching a consensus on each statement of the guideline. This guideline provides evidence-based insights into the prevention, diagnosis and management of infection in Inflammatory Bowel Disease. The project is led by Torsten Kucharzik and Stephan Vavricka, with 25 authors from 15 different countries. This is ECCO’s third guideline on infection in IBD; the first guideline on opportunistic infection was published in 2009, and updated in 2014.
When working on this guideline, we recognised that the infections relevant to our patients were not necessarily ‘opportunistic’, and accordingly we dropped this from the title. Key topics were divided between four working groups; WG1: viral infections, WG2: parasitic, fungal and bacterial infections (including Mycobacterium), WG3: definition of risk factors, paediatrics and special situations and WG4: vaccination. Each working group included both gastroenterologists and infectious diseases experts.
To build the guideline, we followed a structured OCEBM approach. When possible, topics were formatted and researched using a PICO format, by which a population, intervention, comparator and outcome were defined prior to a literature search. The evidence underpinning each statement was graded using OCEBM levels of evidence. Following a systematic literature search, each author drafted statements and text for their allocated topics, which were posted onto an online guidelines platform. Prior to our Consensus Meeting, two rounds of online voting and revisions took place, the second of which also included input from ECCO National Representatives.
One of the key challenges of this project was providing evidence-based guidance whilst also acknowledging the varying burden of infections between different countries and respecting differing national approaches. This was particularly true when considering vaccination. COVID-19 also proved to be a challenge, in more ways than one. We all felt an infectious diseases guideline would be incomplete without statements on COVID-19. However, in this rapidly evolving field, we found our statements quickly became outdated and required further editing. The clinical pressures on each author also increased considerably with each pandemic peak.
We had originally planned to reach consensus in person, in Amsterdam, at UEGW 2020. Alas, the pandemic made this impossible, so we instead met virtually. Particular thanks go out to the authors from America and Canada, who attended the 6-hour meeting during the middle of the night! The final manuscript has been approved by the ECCO Governing Board and the Editor in Chief of JCC – Larry Egan and has been accepted for publication.