The 5th EQAsia External Quality Assessment trial: Campylobacter jejuni / C. coli, Enterococcus faecium / E.faecalis and Streptococcus pneumoniae – 2022

This report summarizes the results of the 5th EQA trial of EQAsia, a Fleming Fund Regional Grant aiming to strengthen the provision of
External Quality Assessment (EQA) services across the One Health sector among National Reference Laboratories / Centres of Excellence in South and Southeast Asia. EQAsia has been granted a 2nd phase (2023 to 2025) to continue to deliver the established EQA for both the Human Health (HH sector) and Food and Animal Health (AH sector) laboratories in the region.

The trial was carried out in September-November 2022 and included bacterial identification and antimicrobial susceptibility testing (AST) of Campylobacter (C. jejuni and C. coli), Enterococcus (E. faecium and E. faecalis) and Streptococcus pneumoniae.

A total of 15 HH and six AH laboratories participated and submitted results for the EQA, corresponding to 19 participating laboratories in the E. faecium/ E. faecalis trial, 17 for the S. pneumoniae trial, and three for the C. jejuni/ C. coli trial. These laboratories are from 12
countries situated in South and Southeast Asia (Bangladesh, Bhutan, Brunei Darussalam, Indonesia, Laos People Democratic Republic,
Malaysia, Nepal, Pakistan, Papua New Guinea, Philippines, Sri Lanka and Timor-Leste).

The bacterial identification component consisted in identifying the five strains of the organism in question (target organism) among a total of seven strains. Only three AH laboratories participated and submitted results for the bacterial identification component of the C. jejuni/ C. coli trial, which revealed no issues with correctly identifying the tested strains. For the E. faecium/ E. faecalis trial, misidentification of the non-E. faecium/ E. faecalis strains was the major contributor for the deviations observed in this component, whereas misidentification of the S. pneumoniae strains was generally problematic, especially among the AH laboratories. C. jejuni/ C. coli strains were only tested by two laboratories, where ciprofloxacin and gentamicin presented quite high deviations.

E. faecium/ E. faecalis AST results revealed that apart from few exceptions, the majority of the laboratories are proficient at testing ampicillin, teicoplanin and tetracycline, as well as chloramphenicol, linezolid and tigecycline (median deviation of 0%, with some outliers and dispersed deviations). On the contrary, the median deviation was ≥ 10% for gentamicin and daptomycin, the latter tested by only four laboratories, which presented varying deviations.

In the S. pneumoniae trial, amoxicillin/clavulanic acid, ertapenem, levofloxacin and linezolid, as well as tetracycline and vancomycin had median deviations of 0% (the last two antimicrobials with a few outliers), whereas azithromycin, cefotaxime, ceftriaxone, chloramphenicol, clindamycin, erythromycin, penicillin and trimethoprim/sulfamethoxazole generated higher and more dispersed deviations. Cefepime, cefuroxime and meropenem were tested by less than five laboratories.

In general, the median deviation was below the acceptance level of 5% deviation from expected results in the S. pneumoniae trial, whereas the E. faecium/ E. faecalis trial presented a median deviation close to 10%. For the C. jejuni/ C. coli trial, the two laboratories that performed AST presented deviations of 0 and 25.0%. It is noticeable that the deviations observed for the trials are disperse, suggesting that the level of proficiency varies among the participating laboratories.

The two participating laboratories in the C. jejuni/ C. coli trial submitted results concerning the reference strain, 16 laboratories for the E.
faecium/ E. faecalis trial, and 13 laboratories for the S. pneumoniae trial, meaning that in the E. faecium/ E. faecalis trial, results from three laboratories were missing (two HH laboratories did not submit results and results from one AH laboratory could not be assessed), and four laboratories, two from each sector, did not submit results for the reference strain in the S. pneumoniae trial. None of the participants in the C. jejuni/ C. coli trial reported deviations from the expected results. For the E. faecium/ E. faecalis trial the median deviation was 0%, whereas the median deviation for the S. pneumoniae trial was above 15%, with quite disperse deviations in both of the trials.