Improvements in antimicrobial reporting in Australian and New Zealand laboratories after publication of national guidelines: a follow-up survey from the Royal College of Pathologists of Australasia Quality Assurance Programs

Objectives In 2017, a Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP) laboratory survey demonstrated suboptimal antimicrobial susceptibility reporting practices. In response, the RCPA published Selective Reporting of Antimicrobials Guidelines to support selective and cascade reporting of antimicrobials. We sought to revisit laboratory antimicrobial reporting practices since these guidelines were published. Materials and methods We carried out a repeat of the laboratory survey in 2023 and compared results to the previous 2017 report. We also studied antimicrobial reporting practices from two routine external quality assurance (EQA) samples dispatched by the RCPAQAP. Results In 2023, compared with 2017, there was an overall improvement in selective reporting and a reduction in reporting of antibiotics inappropriate for bacteraemia. For a fully susceptible Escherichia coli in blood cultures, fewer laboratories over-reported antibiotics [29/62 (47%) and 55/84 (65%), respectively, P = 0.03] or reported ciprofloxacin [13/55 (24%) and 41/73 (56%), respectively, P = 0.03]. Similarly, for a fully susceptible E. coli in urine, fewer laboratories reported amoxicillin-clavulanate [15/57 (26%) and 44/90 (49%), respectively, P = 0.006] and ciprofloxacin [6/51 (12%) and 12/57 (21%), respectively, P = 0.21]. For a wild-type Klebsiella pneumoniae in blood culture, fewer laboratories reported inappropriate antibiotics for bacteraemia [11/94 (12%) and 1/62 (2%), P = 0.02]. Conclusions We demonstrate an improvement in selective antimicrobial reporting following the publication of national antimicrobial reporting guidelines for laboratories, but opportunities for further improvement and standardization remain. This work is encouraging and highlights how microbiology laboratories can be supported to contribute to antimicrobial stewardship efforts.