During the development of these guidelines we used AGREE criteria for their development [15]. As these guidelines face the task of providing guidance explicitly for rare and emerging fungi, an evidence-based evaluation remains daunting. Nevertheless, the working steps were clear and developed and communicated within the group:
1.
Scope and Purpose:All diseases and their corresponding patient groups were predefined and appropriately covered by the guideline.
2.
Stakeholder involvement:Due to the nature of the guideline meaning that the incidence rates are low and diversity of patient groups is wide, patients’ views could not be sought. But the end-users were clearly defined by these guidelines.These guidelines are made in collaboration between ECMM and ESCMID.
3.
Rigour of development: The steps of development are similar to those used for the previous guideline of our group [14]:
a.
Defining the rare and emerging fungi.
b.
Several manuscripts of individual writing groups that were established with separate chairs and corresponding mandates composed these guidelines. The entire guideline project was then reviewed by the whole guideline group.
c.
Predefining questions that need to be answered.
d.
Providing alternative answers, all weighted by the body of evidence.
e.
Literature research was performed in PubMed with predefined search algorithms including major scientific meetings (e.g. ICAAC and ECCMID).
f.
Slide kits were prepared and circulated within the whole group for commentary.
g.
Presentation of the guidelines during ECCMID 2013.
h.
Manuscript is prepared including all valid commentary during the ECCMID and again circulated within the entire group for approval.
i.
An updated guideline will be routinely available after 4–5 years after the previous publication. An earlier update will follow if new and striking changes are found in the body of evidence.
4.
Clarity of presentation:
a.
All recommendations are specific and unambiguous. The major messages are provided in tables designed to be easily read and understood.
b.
Clear statements of the intention of each single recommendation and clarity regarding its intervention.
5.
Applicability:
a.
One of the early criteria required by AGREE was the request to consider the potential cost implication by the application of the given recommendation. This is not really feasible in a European guideline because reimbursements differ between countries and some only look at acquisition cost without considering the other outcome analyses. Therefore this criterion could not be considered for each recommendation.
b.
The guidelines want to provide clear guidance to each clinician and microbiologist and recommend adaptation and individual modifications according to each hospital or country’s epidemiology and abilities, without considering itself to be the whole truth of diagnosis or treatment.
6.
Editorial independence:
a.
These guidelines are free of any pharmaceutical company influence. No single member of pharmaceutical companies was present during the guideline discussions.
b.
A grant was provided for the development of these guidelines by ESCMID and ECMM.
c.
The guideline was peer-reviewed before its publication.