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. 2019 Mar 25;19(1):281.
doi: 10.1186/s12879-019-3900-z.

Ten years of external quality assessment (EQA) of Neisseria gonorrhoeae antimicrobial susceptibility testing in Europe elucidate high reliability of data

Michelle J Cole  1 , Nerteley Quaye  2 , Susanne Jacobsson  3 , Michaela Day  4 , Elizabeth Fagan  5 , Catherine Ison  6 , Rachel Pitt  4 , Shila Seaton  5 , Neil Woodford  4 , Angelika Stary  7 , Sonja Pleininger  8 , Tania Crucitti  9 , Blaženka Hunjak  10 , Panayiota Maikanti  11 , Steen Hoffmann  12 , Jelena Viktorova  13 , Susanne Buder  14 , Peter Kohl  14 , Eva Tzelepi  15 , Eirini Siatravani  15 , Eszter Balla  16 , Guðrún Svanborg Hauksdóttir  17 , Lisa Rose  18 , Paola Stefanelli  19 , Anna Carannante  19 , Gatis Pakarna  20 , Francesca Mifsud  21 , Rosann Zammit Cassar  21 , Ineke Linde  22 , Thea Bergheim  23 , Martin Steinbakk  24 , Beata Mlynarczyk-Bonikowska  25 , Maria-José Borrego  26 , Jill Shepherd  27 , Peter Pavlik  28 , Samo Jeverica  29 , Julio Vazquez  30 , Raquel Abad  30 , Sabrina Weiss  4   31   32 , Gianfranco Spiteri  32 , Magnus Unemo  3
Affiliations

Ten years of external quality assessment (EQA) of Neisseria gonorrhoeae antimicrobial susceptibility testing in Europe elucidate high reliability of data

Michelle J Cole et al. BMC Infect Dis. .

Abstract

Background: Confidence in any diagnostic and antimicrobial susceptibility testing data is provided by appropriate and regular quality assurance (QA) procedures. In Europe, the European Gonococcal Antimicrobial Susceptibility Programme (Euro-GASP) has been monitoring the antimicrobial susceptibility in Neisseria gonorrhoeae since 2004. Euro-GASP includes an external quality assessment (EQA) scheme as an essential component for a quality-assured laboratory-based surveillance programme. Participation in the EQA scheme enables any problems with the performed antimicrobial susceptibility testing to be identified and addressed, feeds into the curricula of laboratory training organised by the Euro-GASP network, and assesses the capacity of individual laboratories to detect emerging new, rare and increasing antimicrobial resistance phenotypes. Participant performance in the Euro-GASP EQA scheme over a 10 year period (2007 to 2016, no EQA in 2013) was evaluated.

Methods: Antimicrobial susceptibility category and MIC results from the first 5 years (2007-2011) of the Euro-GASP EQA were compared with the latter 5 years (2012-2016). These time periods were selected to assess the impact of the 2012 European Union case definitions for the reporting of antimicrobial susceptibility.

Results: Antimicrobial susceptibility category agreement in each year was ≥91%. Discrepancies in susceptibility categories were generally because the MICs for EQA panel isolates were on or very close to the susceptibility or resistance breakpoints. A high proportion of isolates tested over the 10 years were within one (≥90%) or two (≥97%) MIC log2 dilutions of the modal MIC, respectively. The most common method used was Etest on GC agar base. There was a shift to using breakpoints published by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) in the latter 5 years, however overall impact on the validity of results was limited, as the percentage categorical agreement and MIC concordance changed very little between the two five-year periods.

Conclusions: The high level of comparability of results in this EQA scheme indicates that high quality data are produced by the Euro-GASP participants and gives confidence in susceptibility and resistance data generated by laboratories performing decentralised testing.

Keywords: EUCAST; Euro-GASP; European Union (EU); European economic area (EEA); Gonorrhoea.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests. However, PHE’s AMRHAI Reference Unit has received financial support for conference attendance, lectures, research projects or contracted evaluations from numerous sources, including: Accelerate Diagnostics, Achaogen Inc., Allecra Therapeutics, Amplex, AstraZeneca UK Ltd., AusDiagnostics, Basilea Pharmaceutica, Becton Dickinson Diagnostics, bioMérieux, Bio-Rad Laboratories, BSAC, Cepheid, Check-Points B.V., Cubist Pharmaceuticals, Department of Health, Enigma Diagnostics, Food Standards Agency, GlaxoSmithKline Services Ltd., Helperby Therapeutics, Henry Stewart Talks, IHMA Ltd., Innovate UK, Kalidex Pharmaceuticals, Melinta Therapeutics, Merck Sharpe & Dohme Corp., Meiji Seika Pharma Co. Ltd., Mobidiag, Momentum Biosciences Ltd., Neem Biotech, Nordic Pharma Ltd., Norgine Pharmaceuticals, Rempex Pharmaceuticals Ltd., Roche, Rokitan Ltd., Smith & Nephew UK Ltd., Shionogi & Co. Ltd., Speedx, Trius Therapeutics, VenatoRx Pharmaceuticals and Wockhardt Ltd.

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Figures

Fig. 1
Fig. 1
Overall antimicrobial susceptibility category agreement in the European gonococcal External Quality Assessments (EQAs), 2007–2016 (no EQA in 2013). Note: Cefixime was not tested before 2010
Fig. 2
Fig. 2
MIC concordance within one and two MIC log2 dilutions of the modal MIC in the European gonococcal External Quality Assessments (EQAs), 2007–2016 (no EQA in 2013). *contains isolates from 2010 (11–15) and 2011 (1–15)
See this image and copyright information in PMC

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