Proficiency of WHO Global Foodborne Infections Network External Quality Assurance System Participants in Identification and Susceptibility Testing of Thermotolerant Campylobacter spp. from 2003 to 2012

Abstract

Campylobacter spp. are foodborne and waterborne pathogens. While rather accurate estimates for these pathogens are available in industrialized countries, a lack of diagnostic capacity in developing countries limits accurate assessments of prevalence in many regions. Proficiency in the identification and susceptibility testing of these organisms is critical for surveillance and control efforts. The aim of the study was to assess performance for identification and susceptibility testing of thermotolerant Campylobacter spp. among laboratories participating in the World Health Organization (WHO) Global Foodborne Infections Network (GFN) External Quality Assurance System (EQAS) over a 9-year period. Participants (primarily national-level laboratories) were encouraged to self-evaluate their performance as part of continuous quality improvement. The ability to correctly identify Campylobacter spp. varied by year and ranged from 61.9% (2008) to 90.7% (2012), and the ability to correctly perform antimicrobial susceptibility testing (AST) for Campylobacter spp. appeared to steadily increase from 91.4% to 93.6% in the test period (2009 to 2012). The poorest performance (60.0% correct identification and 86.8% correct AST results) was observed in African laboratories. Overall, approximately 10% of laboratories reported either an incorrect identification or antibiogram. As most participants were supranational reference laboratories, these data raise significant concerns regarding capacity and proficiency at the local clinical level. Addressing these diagnostic challenges is critical for both patient-level management and broader surveillance and control efforts.

Keywords: Campylobacter coli; Campylobacter jejuni; Global Foodborne Infections Network; World Health Organization; antimicrobial susceptibility testing; identification; proficiency test; quality assurance.

FIG 1

Map indicating the participating countries colored with respect to the region to which they belong (Africa, Asia/Middle East, Caribbean, Europe, Latin America, North America, Oceania, Russia, or Southeast Asia). Performance with regard to the species identification and antimicrobial susceptibility testing is indicated as average % of correct results. The 96 participating countries included the following, by region: in Africa, Algeria, Botswana, Cameroon, Central African Republic, Republic of the Congo, Egypt, Ethiopia, Gambia, Gabon, Ivory Coast, Kenya, Madagascar, Malawi, Mauritius, Morocco, Senegal, South Africa, Sudan, and Tunisia; in Asia and the Middle East, China, Islamic Republic of Iran, Israel, Kuwait, Oman, and Saudi Arabia; in the Caribbean, Barbados, Grenada, Jamaica, and Trinidad and Tobago; in Europe, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, Germany, Greece, Hungary, Iceland, Italy, Latvia, Lithuania, Luxembourg, Macedonia, Malta, Republic of Moldova, The Netherlands, Norway, Poland, Romania, Serbia, Slovakia, Slovenia, Spain, and Turkey; in Latin America, Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Mexico, Panama, Paraguay, Peru, Suriname, Uruguay, and Venezuela; in North America, Canada, and the United States; in Oceania, Australia, New Caledonia, and New Zealand; in the Russian region, Belarus, Georgia, Russian Federation, and Ukraine; and in Southeast Asia, Brunei Darussalam, Cambodia, India, Japan, Republic of Korea, Lao People's Democratic Republic, Malaysia, the Philippines, Singapore, Sri Lanka, Taiwan, Thailand, and Vietnam.

FIG 2

Species identification of Campylobacter. Summary of the performance per year of results covering all nine participating regions (Africa, Asia/Middle East, Caribbean, Europe, Latin America, North America, Oceania, Russia, and Southeast Asia).

FIG 3

Species identification of Campylobacter coli and C. jejuni. Summary of the performance per region of results over the years 2003 to 2012 (excluding 2005).

FIG 4

Antimicrobial susceptibility testing of Campylobacter spp. showing the performance per year and region.

FIG 5

Antimicrobial susceptibility testing of Campylobacter spp. Summary of the performance per year of results covering all nine participating regions (Africa, Asia/Middle East, Caribbean, Europe, Latin America, North America, Oceania, Russia, and Southeast Asia).