In 2016, the RCPA initiated the formation of a committee comprised of Medical Microbiologists to establish guidelines to assist Australian laboratories to implement selective reporting of antimicrobials - the first guideline of this type in the world. A/Prof Maryza Graham has been a member of the RCPA Microbiology Advisory Committee for the past nine years and is the current Chair of the National RCPA Selective Reporting of Antimicrobials Guidelines Committee. She explains that research has shown that selective reporting of antibiotics can influence prescribing practice.
“When we perform tests on bacteria that are grown in the laboratory, we often test a panel of say 14 antibiotics. Selective reporting means that we don’t report all the results to the treating doctors, rather we try and report the antibiotics that are more likely to be appropriate. This is because some antibiotics are very broad, meaning they attack many bacteria, and some are very narrow and only treat particular bacteria. Appropriateness of antibiotics can also be dependent on the site of infection, patient age and pregnancy status. Many microbiology laboratories provide this service to help clinicians choose when and what to prescribe, as part of optimal Pathology stewardship said Dr Graham.
Pathology stewardship is a tool used by microbiology laboratories to help prescribers choose antimicrobials wisely. It helps clinicians choose the right test at the right time, understand the limitations of a result, choose the most appropriate antimicrobial therapy if required, and modify antimicrobial therapy when resistance to initial therapy is identified. Pathology stewardship has been shown to improve patient outcomes, reduce inappropriate antimicrobial prescribing and decrease antimicrobial resistance.
“What we are trying to do is show that the way that laboratories report antibiotics can help improve appropriate treatments by using our expertise to report what is most appropriate. It’s a hot topic right now – appropriate antibiotic use can minimise harm. They are a resource that we should use wisely, we shouldn’t use them when they are not needed, and we should aim to use the ones that lead to most benefit and least harm. Using unnecessarily broad antibiotics can lead to antimicrobial resistance, which is predicted to be one of the most significant problems we face in in the future. However, we can try and prevent that through the way that we report antibiotics,” said Dr Graham. The guideline aims to reduce prescribing of broad-spectrum antibiotics when they are not required
A 2017 RCPA audit of antimicrobial reporting in Australian and New Zealand Laboratories identified significant opportunities for improvement and standardisation of selective reporting. The first version of the RCPA Selective Reporting guidelines was released by the College in February 2019. Subsequently, New Zealand adapted these guidelines for formulation of their own national guidelines to accommodate local needs.
“The use of these guidelines is still subject to the pathologist’s judgement for each individual case. If antimicrobial susceptibility results that would not be normally reported are requested (e.g. for patients with antibiotic allergies), a discussion between the microbiologist and requesting clinician may be suggested,” said Dr Graham.