Abstract
This report summarizes the results of the 9th 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 2024 and included bacterial identification and antimicrobial susceptibility testing (AST) of several prominent WHO and FAO priority pathogens: Shigella spp, Enterococcus faecalis, Enterococcus faecium, Campylobacter coli, Campylobacter jejuni, and Neisseria gonorrhoeae. The latter isolate was introduced for the second time in this EQA programme since the start of the EQAsia project.
A total of 35 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 42 laboratories for the Shigella spp. panel, 30 laboratories for the E. faecalis/E. faecium panel, 18 – for Campylobacter spp., and 15 – 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 required laboratories to correctly identify five target strains among a total of seven provided strains. For the Shigella spp. panel, identification results from nearly all laboratories aligned with the baseline results. However, identification proved more challenging in the other three panels.
While the trial successfully evaluated laboratory performance across most panels, challenges arose with the Neisseria gonorrhoeae strains, as none of the participating laboratories were able to successfully revive them. A review of the process identified preservation-related challenges that affected strain viability. Although data could not be generated for Neisseria gonorrhoeae in this round, ongoing efforts are focused on refining preservation and shipment strategies to strengthen future EQA trials and ensure the reliability of distributed materials.
On average, the AST performance of participating laboratories was the best in the Shigella spp. panel (93.8.6%), followed by enterococci (96.9%) and Campylobacter spp. (86.3%).
Laboratories were ranked from #1 to #36 based on their based on their average AST score across the panels in which they participated. One laboratory did not submit any data and was not ranked. Several laboratories received the same rank due to identical scores, resulting in 36 total ranking positions. The average score varied between 68.1% (rank #36) and 100% (rank #1). The total average score among all 48 laboratories that submitted results was 91.8%.
As with previous EQAsia EQAs, many of the laboratories were struggling the most with quality control strain testing. Several laboratories (6 in the Shigella spp. Panel, 4 in the enterococci panel and 6 in the Campylobacter spp. Panel, did not submit results from reference strain testing at all. The rate of laboratories whose tested the QC strains and whose results was conform the expected range of QC values varied across the three panels, as follows – Shigella spp. (36.1%), enterococci (66.7%), and Campylobacter spp. (100%).
Several reference strains for the microbiology diagnostics of gonococci were sent to participating laboratories for the second 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 purposes.
The EQA trial was carried out in October - November 2024 and included bacterial identification and antimicrobial susceptibility testing (AST) of several prominent WHO and FAO priority pathogens: Shigella spp, Enterococcus faecalis, Enterococcus faecium, Campylobacter coli, Campylobacter jejuni, and Neisseria gonorrhoeae. The latter isolate was introduced for the second time in this EQA programme since the start of the EQAsia project.
A total of 35 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 42 laboratories for the Shigella spp. panel, 30 laboratories for the E. faecalis/E. faecium panel, 18 – for Campylobacter spp., and 15 – 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 required laboratories to correctly identify five target strains among a total of seven provided strains. For the Shigella spp. panel, identification results from nearly all laboratories aligned with the baseline results. However, identification proved more challenging in the other three panels.
While the trial successfully evaluated laboratory performance across most panels, challenges arose with the Neisseria gonorrhoeae strains, as none of the participating laboratories were able to successfully revive them. A review of the process identified preservation-related challenges that affected strain viability. Although data could not be generated for Neisseria gonorrhoeae in this round, ongoing efforts are focused on refining preservation and shipment strategies to strengthen future EQA trials and ensure the reliability of distributed materials.
On average, the AST performance of participating laboratories was the best in the Shigella spp. panel (93.8.6%), followed by enterococci (96.9%) and Campylobacter spp. (86.3%).
Laboratories were ranked from #1 to #36 based on their based on their average AST score across the panels in which they participated. One laboratory did not submit any data and was not ranked. Several laboratories received the same rank due to identical scores, resulting in 36 total ranking positions. The average score varied between 68.1% (rank #36) and 100% (rank #1). The total average score among all 48 laboratories that submitted results was 91.8%.
As with previous EQAsia EQAs, many of the laboratories were struggling the most with quality control strain testing. Several laboratories (6 in the Shigella spp. Panel, 4 in the enterococci panel and 6 in the Campylobacter spp. Panel, did not submit results from reference strain testing at all. The rate of laboratories whose tested the QC strains and whose results was conform the expected range of QC values varied across the three panels, as follows – Shigella spp. (36.1%), enterococci (66.7%), and Campylobacter spp. (100%).
Several reference strains for the microbiology diagnostics of gonococci were sent to participating laboratories for the second 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 purposes.
| Original language | English |
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| Publisher | DTU National Food Institute |
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| Number of pages | 75 |
| ISBN (Print) | 978-87-7586-053-1 |
| Publication status | Published - 2025 |
