7th EQAsia External Quality Assessment trial: Salmonella spp., Enterococcus spp., Campylobacter spp. and Neisseria gonorrhoeae – 2023

Tomislav Simeonov Kostyanev, Hiba Al Mir, Rangsiya Prathan, Sarah Marvig Johansson, Pattrarat Chanchaithong, Elif Seyda Tosun, Taradon Luangtongkum, Freshwork A. Abegaz, Tobin Guarnacci, Nimesh Poudyal, Lone Brink Rasmussen, Soo-Young Kwon, Rungtip Chuanchuen, Rene S. Hendriksen

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This report summarizes the results of the 7th 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 has entered 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 EQA trial was carried out in October - November 2023 and included bacterial identification and antimicrobial susceptibility testing (AST) of several prominent WHO and FAO priority pathogens: Salmonella spp, Enterococcus faecalis, Enterococcus faecium, Campylobacter coli, Campylobacter jejuni, and Neisseria gonorrhoeae. The latter isolate was introduced for the first time in this EQA programme since the start of the EQAsia project.

A total of 20 HH and 16 AH laboratories participated in this EQA trial. 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). Similarly to 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 33 laboratories for the Salmonella spp. panel, 24 laboratories for the E. faecalis/E. faecium panel, 11 – for Campylobacter spp., and 8 – for N. gonorrhoeae.

A major challenge for several laboratories in this EQA trial appeared to be the reconstitution and isolation of a number of strains from the Campylobacter spp. and N. gonorrhoeae panels. This led to fewer isolates reported per panel and ultimately to a lower performance score.

The bacterial identification component consisted in identifying the five strains of the organism in question (target organism) among a total of seven strains. The identification results from almost all laboratories that submitted data from the Salmonella spp. panel were conform the baseline results. Identification appeared to be more challenging in the other three panels.

On average, the AST performance of participating laboratories was the best in the Salmonella spp. panel (94.6%), followed by enterococci (92.6%), Campylobacter spp. (90.3%), and N. gonorrhoeae (85.2%).

Laboratories were ranked from #1 to #35 (one laboratory did not submit any data) based on their average score across the panels in which they participated. The average score varied between 78.4% (rank #35) and 99.2% (rank #1). The total average score among all 35 laboratories that submitted results was 92.8%, while the median was 93.6%.

As with previous EQAsia EQAs, many of the laboratories were struggling the most with quality control strain testing. Several laboratories (1 in the Salmonella spp. and N. gonorrhoeae panels each, 2 in the enterococci panel and 4 in the Campylobacter spp. panel) did not submit results from reference strain testing at all. The rate of laboratories whose results was conform the expected range of QC values varied across the four panels, as follows – Salmonella spp. (57.6%), enterococci (45.8%), Campylobacter spp. (27.3%), and N. gonorrhoeae (100%).

Several reference strains for the microbiology diagnostics of gonococci were sent to participating laboratories for the first time within this EQA round. Laboratories need to make sure they have all necessary quality control strains that should be tested on a regular basis. EQAsia has also prioritized quality control of AST as a training topic and is offering continuous support on this matter.

Overall, the results from this EQAsia EQA flag once more the need to focus on both basic and more advance methodologies for culture, identification, and antimicrobial susceptibility testing within a training curriculum for the participating laboratories. Quality control testing and the use of the appropriate reference strains, as well as the translation of the QC results into corrective action by laboratories is of utmost importance to ensure a decent level of quality in a microbiology laboratory. Providing and maintaining a standardized level of credible diagnostic services would allow laboratories to generate reliable results that would ultimately feed in a pool of reliable data for surveillance purposes5
Original languageEnglish
PublisherTechnical University of Denmark
Number of pages75
ISBN (Print)978-87-7586-028-9
Publication statusPublished - 2024


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