Abstract
This report summarizes the results of the 6th External Quality Assessment (EQA) trial of EQAsia, the Fleming Fund Regional Grant aiming to strengthen the provision of EQA services across the One Health sector among National Reference Laboratories / Centres of Excellence in South and Southeast Asia. The EQAsia project is entering a second phase (2023 to 2025) in which it will continue to deliver the established EQA programme for both the Human Health (HH sector) and Food and Animal Health (AH sector) laboratories in the region.
The trial was carried out in April – June 2023 and included bacterial identification and antimicrobial susceptibility testing (AST) of four prominent WHO and FAO priority pathogens: Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus.
A total of 23 HH and nine AH laboratories participated in this EQA trial. One HH laboratory did not submit any results. As during the previous EQAsia EQAs, participating laboratories could choose one or more panels among the ones offered in the current EQA round. In total, data were submitted by 29 laboratories for the E. coli panel, 28 laboratories for the K. pneumoniae panel, 23 – for P. aeruginosa, and 28 – for S. aureus. The participating laboratories were from 14 countries situated in South and Southeast Asia (Bangladesh, Bhutan, Brunei Darussalam, Indonesia, Laos People Democratic Republic, Malaysia, the Maldives, Nepal, Pakistan, Papua New Guinea, Philippines, Sri Lanka, Timor-Leste, and Vietnam).
The bacterial identification component consisted in identifying the five strains of the organism in question (target organism) among a total of seven strains. All participating laboratories identified all P. aeruginosa isolates correctly. In the other three panels, there were only one or two laboratories that had difficulties in determining the correct bacterial identification of the target isolates.
Overall, laboratories had a very good performance score throughout all four panels. The success rate in the E. coli and K. pneumoniae panel was the highest (95.5% and 95.9%, respectively), followed by P. aeruginosa – 94.5% and S. aureus – 93.9%.
In this EQA trial, laboratories were ranked for the first time based on their average score across the panels in which they participated. The average score varied between 81.8% (rank #31) and 99.3% (rank #1). The total average score among all 31 laboratories that submitted results was 93.6%, while the median was 94.1%.
As with previous EQAsia EQAs, many of the laboratories were struggling the most with the results obtained when testing quality control strains. Several laboratories (3 in the P. aeruginosa panel and 5 in the S. aureus panel) did not submit results from reference strain testing at all. For the E. coli EQA round, there were ten laboratories (7 HH and 3 AH) that did not have deviation in their quality control results. However, all the other laboratories (n=19) presented deviations between 5.6% and 63.2%. Since the same quality control strains were used also for the K. pneumoniae panel, the submitted results were similar. Nine laboratories (7 HH and 2 AH) showed no deviations, while the results from the other 18 laboratories deviated ranging between 5.6% to 65%. There was much less heterogeneity in the P. aeruginosa panel where the deviations were between 9.1% and 42.9%. The results from the quality control testing also for S. aureus varied substantially between the different laboratories with deviations from the QC ranges between 9.1% and 40%.
Not all laboratories from both HH and AH sectors submitted results for ESBL-, AmpC-, or carbapenemase-production for the E. coli and K. pneumoniae isolates. This rate was however higher for the HH laboratories. 17 HH (59%) and 5 AH (17%) out of 29 laboratories tested and submitted results for E. coli, while 19 HH (68%) and 4 AH (14%) out of 28 laboratories tested and submitted results for K. pneumoniae.
Overall, the results from this EQAsia EQA flag once more the necessity to focus on continuous training and capacity building that underlines the importance of quality control testing in laboratories from both HH and AH sector. Laboratories need to make sure they have a good quality management system set in place that allows for constant improvement in their routine practice. Providing and maintaining a standardized level of credible diagnostic services would allow laboratories to generate reliable results.
Therefore, laboratories need to ensure they have all necessary quality control strains that should be tested on a regular basis. Furthermore, action needs to be taken every time the results from the quality control testing deviate from the ranges set in the methodological standards used.
A special emphasis needs to be placed also on introducing methods that enable the detection of multidrug-resistant pathogens, such as ESBL- and carbapenemase-producing Gram-negatives.
The trial was carried out in April – June 2023 and included bacterial identification and antimicrobial susceptibility testing (AST) of four prominent WHO and FAO priority pathogens: Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus.
A total of 23 HH and nine AH laboratories participated in this EQA trial. One HH laboratory did not submit any results. As during the previous EQAsia EQAs, participating laboratories could choose one or more panels among the ones offered in the current EQA round. In total, data were submitted by 29 laboratories for the E. coli panel, 28 laboratories for the K. pneumoniae panel, 23 – for P. aeruginosa, and 28 – for S. aureus. The participating laboratories were from 14 countries situated in South and Southeast Asia (Bangladesh, Bhutan, Brunei Darussalam, Indonesia, Laos People Democratic Republic, Malaysia, the Maldives, Nepal, Pakistan, Papua New Guinea, Philippines, Sri Lanka, Timor-Leste, and Vietnam).
The bacterial identification component consisted in identifying the five strains of the organism in question (target organism) among a total of seven strains. All participating laboratories identified all P. aeruginosa isolates correctly. In the other three panels, there were only one or two laboratories that had difficulties in determining the correct bacterial identification of the target isolates.
Overall, laboratories had a very good performance score throughout all four panels. The success rate in the E. coli and K. pneumoniae panel was the highest (95.5% and 95.9%, respectively), followed by P. aeruginosa – 94.5% and S. aureus – 93.9%.
In this EQA trial, laboratories were ranked for the first time based on their average score across the panels in which they participated. The average score varied between 81.8% (rank #31) and 99.3% (rank #1). The total average score among all 31 laboratories that submitted results was 93.6%, while the median was 94.1%.
As with previous EQAsia EQAs, many of the laboratories were struggling the most with the results obtained when testing quality control strains. Several laboratories (3 in the P. aeruginosa panel and 5 in the S. aureus panel) did not submit results from reference strain testing at all. For the E. coli EQA round, there were ten laboratories (7 HH and 3 AH) that did not have deviation in their quality control results. However, all the other laboratories (n=19) presented deviations between 5.6% and 63.2%. Since the same quality control strains were used also for the K. pneumoniae panel, the submitted results were similar. Nine laboratories (7 HH and 2 AH) showed no deviations, while the results from the other 18 laboratories deviated ranging between 5.6% to 65%. There was much less heterogeneity in the P. aeruginosa panel where the deviations were between 9.1% and 42.9%. The results from the quality control testing also for S. aureus varied substantially between the different laboratories with deviations from the QC ranges between 9.1% and 40%.
Not all laboratories from both HH and AH sectors submitted results for ESBL-, AmpC-, or carbapenemase-production for the E. coli and K. pneumoniae isolates. This rate was however higher for the HH laboratories. 17 HH (59%) and 5 AH (17%) out of 29 laboratories tested and submitted results for E. coli, while 19 HH (68%) and 4 AH (14%) out of 28 laboratories tested and submitted results for K. pneumoniae.
Overall, the results from this EQAsia EQA flag once more the necessity to focus on continuous training and capacity building that underlines the importance of quality control testing in laboratories from both HH and AH sector. Laboratories need to make sure they have a good quality management system set in place that allows for constant improvement in their routine practice. Providing and maintaining a standardized level of credible diagnostic services would allow laboratories to generate reliable results.
Therefore, laboratories need to ensure they have all necessary quality control strains that should be tested on a regular basis. Furthermore, action needs to be taken every time the results from the quality control testing deviate from the ranges set in the methodological standards used.
A special emphasis needs to be placed also on introducing methods that enable the detection of multidrug-resistant pathogens, such as ESBL- and carbapenemase-producing Gram-negatives.
| Original language | English |
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| Publisher | National Food Institute |
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| Number of pages | 83 |
| Publication status | Published - 2023 |
