External quality assessment (EQA) combined with on-site technical evaluation for capacity building in clinical microbiology laboratories in Pakistan

Saeed, Noureen; Zeeshan, Muhammad; Saeed, Dania Khalid; Farooqi, Joveria; Shakoor, Sadia; Ahmed, Imran; Jabeen, Kauser; Rao, Jason; Hasan, Rumina

doi:10.1007/s00769-022-01495-x

Cited by 2 publications

(2 citation statements)

References 11 publications

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“…Sustained engagement in EQA programs results in improved testing quality and performance of participating laboratories in pathogen identification and AST techniques [ 17 ]. The improvement in laboratory performance relies on in-depth analysis and identification of sources of errors that result in poor performance and are promptly addressed by continuous follow-up of the laboratories [ 18 ]. A key reason for poor performance in our study setting is related to inadequate training, poor adherence to standard protocol (eg, following CLSI guidelines for media antibiotic preparation, the inclusion of control strains), and the lack of human resources for rechecking and interpreting AST results.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Quality Management and Diagnostics Microbiology Performance Within an International External Quality Assessment (EQA) Program Serving National One Health Sector Reference Laboratories Across Asia: Experience Amid the Coronavirus Disease 2019 (COVID-19) Pandemic

Abegaz,

dos Santos,

Mogeni

et al. 2023

Clinical Infectious Diseases

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Background Strengthening external quality assessment (EQA) services across the One Health sector supports implementation of effective antimicrobial resistance (AMR) control strategies. Here we describe and compare 2 different approaches for conducting virtual laboratory follow-up assessments within an EQA program to evaluate quality management system (QMS) and procedures for pathogen identification and antimicrobial susceptibility testing (AST). Methods During the coronavirus disease 2019 (COVID-19) pandemic in 2021 and 2022, 2 laboratory assessment approaches were introduced: virtual-based and survey-based methodologies. The evaluation of 2 underperforming Animal Health laboratories through a virtual-based approach occurred between May and August 2021. This evaluation encompassed the utilization of 3 online meetings and document reviews, performed subsequent to the execution of EQA procedures. Within a distinct group of laboratories, the survey-based assessment was implemented from December 2021 to February 2022, also following EQA procedures. This phase encompassed the dissemination of an online survey to 31 participating laboratories, alongside a sole online consultation meeting involving 4 specific underperforming laboratories. Results The virtual-based assessment post-EQA aimed to identify gaps and areas for improvement in the laboratory's practices for pathogen identification and AST. This approach was, however, time-intensive, and, hence, only 2 laboratories were assessed. In addition, limited interactions in virtual platforms compromised the assessment quality. The survey-based post-EQA assessment enabled evaluation of 31 laboratories. Despite limitations for in-depth analysis of each procedure, gaps in QMS across multiple laboratories were identified and tailored laboratory-specific recommendations were provided. Conclusions Reliable internet and plans for efficient time management, post-EQA virtual laboratory follow-up assessments are an effective alternative when conducting onsite evaluation is infeasible as observed during the COVID-19 pandemic, although the successful implementation of remediation plans will likely require in person assessments. We advocate application of hybrid approaches (both onsite and virtual) for targeted capacity building of AMR procedures with the ability to implement and oversee the process.

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Section: Discussionmentioning

confidence: 99%

Evaluating Quality Management and Diagnostics Microbiology Performance Within an International External Quality Assessment (EQA) Program Serving National One Health Sector Reference Laboratories Across Asia: Experience Amid the Coronavirus Disease 2019 (COVID-19) Pandemic

Abegaz,

dos Santos,

Mogeni

et al. 2023

Clinical Infectious Diseases

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“…An initial attempt to assess mycology laboratory capacities in Pakistan for diagnosing invasive fungal infections has been made as part of the Asia/Pacific region 25 . However, a thorough burden assessment of fungal pathogens and evaluation of diagnostic capacities in mycology laboratories is needed across the country, complete with external quality assessment and on‐site laboratory evaluation of public and private laboratories of Pakistan 26 . Variable practices for using antimicrobial agents with or without microbiological evidence, and clinician's confidence in culture and sensitivity reports are other important drivers augmenting the inappropriate antimicrobial use and, hence, emerging resistance in Pakistan 27,28 .…”

Section: Discussionmentioning

confidence: 99%

Fluconazole‐resistant Candida parapsilosis complex candidemia and analysis of mutations in the ERG11 gene from Pakistan

Zeeshan,

Memon,

Malick

et al. 2023

Mycoses

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BackgroundRecent reports of the emergence of fluconazole resistance in Candida parapsilosis species complex poses a challenge, more specifically in settings where echinocandin‐based treatment regime is not feasible.ObjectiveThis study reported emergence of fluconazole resistance in C. parapsilosis species complex strains isolated from blood cultures.Materials and MethodsThis retrospective observational study was conducted from 2018 to 2020 at a tertiary care laboratory from Pakistan. Fluconazole‐resistant C. parapsilosis species complex fungemia cases were identified from laboratory database and clinical details were collected. Identification of C. parapsilosis species complex was done using API 20C AUX and Cornmeal Tween80 agar morphology. Minimum inhibitory concentrations (MICs) were determined using Sensititre YeastONE and interpretation was done with CLSI M60 ED1:2017. ERG11 gene region was amplified and sequenced by Sanger sequencing and analysed by MEGA 11 Software.ResultsA total of 13 (8.5%) fluconazole‐resistant isolates were identified from 152 C. parapsilosis species complex candidemia cases. Fluconazole MICs of resistant isolates ranged between 8 and 256 μg/mL. Analysis of ERG11 gene revealed nonsynonymous mutations at position Y132F in 86% of the fluconazole‐resistant isolates. Diabetes and hospitalization were important risk factors for candidemia with fluconazole‐resistant C. parapsilosis complex.ConclusionThis is the first report of the emergence and molecular mechanisms of fluconazole resistance in C. parapsilosis species complex from Pakistan. Y132F mutation in the ERG11 gene was the most common mutation in fluconazole‐resistant strains. These findings are concerning and necessitate better diagnostics, newer antifungals, ongoing surveillance and further insights on resistance mechanisms in the country.

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External quality assessment (EQA) combined with on-site technical evaluation for capacity building in clinical microbiology laboratories in Pakistan

Cited by 2 publications

References 11 publications

Evaluating Quality Management and Diagnostics Microbiology Performance Within an International External Quality Assessment (EQA) Program Serving National One Health Sector Reference Laboratories Across Asia: Experience Amid the Coronavirus Disease 2019 (COVID-19) Pandemic

Evaluating Quality Management and Diagnostics Microbiology Performance Within an International External Quality Assessment (EQA) Program Serving National One Health Sector Reference Laboratories Across Asia: Experience Amid the Coronavirus Disease 2019 (COVID-19) Pandemic

Fluconazole‐resistant Candida parapsilosis complex candidemia and analysis of mutations in the ERG11 gene from Pakistan

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