A Retrospective, Longitudinal External Study of the robustness and reproducibility of National Antibacterial Prescribing Survey Data

Background Point prevalence surveys are used internationally to audit antibacterial use as well as the impact of interventions on improving prescribing and resistance rates. The annual National Antibacterial Prescribing Survey provides data on the appropriateness of antibacterial agent prescribing in Australian hospitals. Assessing the survey’s robustness and result reproducibility is essential to its role in improving antibacterial prescribing practice. Aim To evaluate the reproducibility of internal assessments of antibacterial agent prescribing of both guideline compliance and appropriateness from a Western Australian hospital. Method Census data of 1051 prescriptions from 2013 to 2017 surveys were independently assessed for compliance based on Australian Therapeutic Guidelines - Antibiotics, and appropriateness, based on agent selection, therapy duration and microbiological test results. Concordance of these findings with internal hospital assessments was analysed. Results This external study did not reproduce internal hospital audit results for compliance with guideline parameters. Non-compliant prescribing rate was significantly (p < 0.001) higher externally at 50.7% (533/1051) than internal assessment at 34.9% (367/1051). External analysis also found a significantly smaller proportion of prescriptions to be appropriate (551/1051, 52.4%) compared to internal analysis (745/1051, 70.9%) p < 0.001. Cohen’s Kappa analysis found a moderate agreement for compliance (0.49) and appropriateness (0.50) between the external and internal evaluations. Conclusion The lack of adequate reproducibility of compliance and appropriateness assessments may limit the generalisability of the audit’s results. Validating point prevalence surveys that assess antibacterial agent prescribing can increase confidence and improve reproducibility of their findings; as they provide important data for antimicrobial stewardship programs.