RCPAQAP audit of antimicrobial reporting in Australian and New Zealand laboratories: opportunities for laboratory contribution to antimicrobial stewardship

Objectives: A 2017 laboratory survey conducted by the Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP) asked participants which antimicrobials they would report for given organisms in either blood or urine cultures in order to identify opportunities for improvement of antimicrobial reporting. Methods: Over-reporting was defined as reporting of broad-spectrum antimicrobials on isolates susceptible to narrow-spectrum antimicrobials. Inappropriate reporting was defined as reporting antimicrobials not appropriate for the site of infection. Results: For a fully susceptible Escherichia coli in blood culture, 65% of laboratories (55/84) over-reported at least one antimicrobial. Importantly, 15% (10/65) of laboratories that tested meropenem reported the result. A significant proportion of laboratories (12%, 10/84) reported antimicrobials generally considered inappropriate for treatment of bacteraemia on blood culture isolates. Overall, 82% (77/94) of laboratories either over-reported or inappropriately reported at least one antimicrobial. Conclusions: This survey identifies significant opportunities for improvement and standardization of 'cascade' or 'selective' reporting of antimicrobials and highlights ways in which microbiology laboratories can contribute to antimicrobial stewardship and judicious use of antimicrobials.