UK NEQAS JULY 2019 NEWSLETTER
UK NEQAS for Microbiology – Keeping Ahead of the Curve
Clinical microbiology is transforming at pace so a key challenge for UK NEQAS Scheme Organisers is to keep abreast of global developments. This helps ensure that the EQA service reflects not only changes in technology, the emergence of new pathogens and alterations to microbial classification and nomenclature, but also remains compliant with regulations about safety and pathogen categorisation and meets laboratories’ accreditation needs.
However, when it comes to test procedures, there is a balance to be struck between the ‘old’ and the ‘new’ and classical tests still have an important role to play in clinical diagnostic bacteriology. A recent study by US scientists of 26,429 cases of meningitis and encephalitis in infants1 indicated that the most commonly requested test was the Gram stain, devised in 1882, yet despite its simplicity, requires a degree of expertise to interpret results correctly. The microbiologists who manufacture and quality control test the UK NEQAS EQA bacteriology samples frequently prepare and interpret Gram stains for a wide range of bacterial strains. Scientists in participating laboratories must also be competent if they are to report accurate results for samples because there is no doubt that correctly reported results for classical tests such as the Gram stain can improve patient outcomes.
Moving forward from 19th century to 21st century technologies, we recognise that pathogen genomics is now widely acknowledged as a powerful tool for investigating and managing infectious diseases. Public Health England was an early adopter in applying whole genome sequencing (WGS) to routine bacteriology service delivery, particularly in their national reference laboratory for gastrointestinal pathogens2, and it is only a matter of time before this technology rolls into routine testing laboratories. The UK NEQAS EQA team are planning and preparing for this, appreciating also that new and different skills will be required.
Sequencing technology continues to reveal virulence factors in bacterial species that have not traditionally been associated with infection. Examples include Staphylococcus scheitzeri and S.argenteus which have been shown to possess genes for virulence factors normally associated with S.aureus3. Genomic characterisation of Streptococcus pseudopneumoniae, an overlooked pathogen emerging as the causative agent of lower respiratory tract infections, has identified multiple virulence factors in this species4. The important educational role of UK NEQAS schemes makes it essential that at least some EQA samples reflect these evolving trends.
Another question for our Organisers: “What’s in a name?” When it comes to microbiology the answer may well be “controversy and disagreement”. Taxonomists are rapidly reclassifying and renaming bacterial, virus and fungal strains as the switch from phenotypic to genotypic criteria challenges historical perceptions of relatedness. Microbial name changes present educational and communication challenges that EQA schemes can help to address since there is real possibility that a medical microbiologist may not recognise or appropriately treat a serious infection due to a name change. For this reason Lawson et al5 took great care to consider this issue when proposing the reclassification of Clostridium difficile as Clostridiodes difficile in 2015; the new name, which can still be abbreviated to C.diff, is only now starting to take precedence.
UK NEQAS EQA Scheme Organisers must use their knowledge, skills and professional networks to make sure that the EQA services support testing laboratories in reporting accurate, correctly interpreted results for every patient specimen in the changing world of clinical microbiology. That’s why they strive to keep ahead of the curve.
UK NEQAS Microbiology staff developing scientists of the future
On 25 June, Vuyelwa Nkomo and I presented at the Hitchhikers Guide to Microbiology, at PHE Colindale. This day-long workshop is a basic microbiology course for non- microbiologists. Attendees are given a brief introduction into microbiology to help them understand the activities carried out within the National Infection Service, PHE.
The presentation covered what activities are undertaken within UK NEQAS and how this contributes towards laboratory diagnostics. An overall view of the life-cycle of a specimen in UK NEQAS for Microbiology was demonstrated, with an emphasis on sample production and preparation for an EQA distribution.
Positive feedback was given by the delegates, whom showed appreciation of the information that was given. There was plentiful interaction during the presentation that allowed the delegates to gain an understanding of the scientific processes that happen within the laboratories.
UK NEQAS Microbiology Scientists of the Future
In March 2019 staff members from Public Health England (PHE) were invited to attend Harlow College as part of a Public Involvement initiative. I represented both PHE and UK NEQAS for Microbiology by volunteering to demonstrate agar plate-streaking to the students who were studying sciences courses.
The students enjoyed the practical experience and were fascinated about why microbiologists use agar plates and the variety of media types for different organisms. In addition, career aspirations, possible university degrees and the importance of the HCPC and IBMS for entering clinical Microbiology was discussed and guidance provided.
The day I spent with the students was great fun and very rewarding to share a passion of mine and inspire the next generation of scientists.
ß-D Glucan Pilot Update
There has been a great interest in ß-D-Glucan (BDG) testing from our participants. Additionally, the vast majority of literature publications highlight the importance of a non-invasive method for the diagnosis and monitoring of invasive fungi. There is an increasing incidence of fungal infections, including primary and opportunistic pathogens, particularly in patients with a compromised immune system.
The main polysaccharide groups of most fungi include glucan, chitin and mannan, with glucan being the most essential and abundant polysaccharide. During an invasive fungal infection (IFI), BDG is released in limited but detectable quantities in the circulation of fungi infected patients. Detection of BDG is a highly effective and sensitive presumptive diagnostic method, and is imperative in immunocompromised patients whom acquire an IFI.
A pilot distribution was sent out in March and July 2019 in order to test for the detection of ß-D Glucan in serum specimens. Another pilot is due to be sent out in the near future, and all of the results will be collated and analysed with a final report feedback.
Carbapenemase Pilot Update
It is well recognised that diagnostic laboratories currently face a challenge with the detection and identification of Gram negative multi resistant organisms. Most diagnostic laboratories have developed protocols for the investigation of multi resistant bacterial strains. However there is no external quality assessment for those methods in place.
The aim is to deliver a scheme that would assess methods of detection of carbapenemase producing organisms in diagnostic laboratories.
As the result of a previous pre-pilot study and data from our mini questionnaire sent along our Antimicrobial Susceptibility (AS) scheme that looked into methods for Carbapenemase Producing Enterobacteriaceae (CPE) detection in diagnostic laboratories, we are now planning to enrol for a pilot distribution later on this year.
Development Of Sepsis EQA
We are delighted that our abstract submitted to IBMS to present a poster on the development of EQA for detection of sepsis has been accepted.
Sepsis develops when a bacterial infection gets into the blood stream, which results in the triggering of a violent and potentially fatal immune response. Sepsis is often misdiagnosed so it is important that clinical laboratories are able to participate in EQA for diagnosing blood stream infections.
Come along and learn more about what we are doing to develop an EQA scheme for detection of sepsis at the International Convention Centre (ICC) in Birmingham between 22nd and 25th September 2019.
We look forward to seeing you there.
Both UK NEQAS and Parasitology are currently undergoing their respective annual accreditation.
MEETINGS ATTENDED BY UK NEQAS TEAM
Standardisation of Genome Amplification Techniques (SoGat) 2019
The 28th International workshop on standardisation was hosted at the MHRA headquarters in Canary Wharf, London, UK. The session combined a series of expert lectures and round table discussions addressing current challenges in the standardisation of molecular diagnostic assays. The event aimed to promote standardisation of diagnostic assays through inter-laboratory comparison studies or collaborations with EQA providers. Cangul Seran from the Virology and Molecular UK NEQAS team attended this workshop to gain insight into:
- New and emerging viruses that require the implementation of WHO international standards including the West Nile, Zika, Dengue, and Chikungunya Viruses
- Progressive WHO diagnostic standardisation projects
- HPV variants and development of appropriate reference materials
- Development of international standards for Influenza A/B and HCV RNA
- Infectious disease assays that continue to require reference materials such as Coronaviruses and HIV-1 Group O virus.
- Standardising Point of Care testing
The workshop helped envisage the service UK NEQAS provide in a broader context and reinforce the importance of the services offered by UK NEQAS. The presentations included collaborators and colleagues from Public Health England. It was an exciting opportunity to interact and engage in conversations related to EQA and the improvement of diagnostic assays.
This year, the 29th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2019), was held in Amsterdam, Netherlands on the 13-16 April 2019. More than 12,000 participants from around the world attended, with more than 3,000 abstracts presented at the congress as oral sessions, posters or e-Posters.
Three UK NEQAS Microbiology & UK NEQAS Parasitology staff were successful in having abstracts accepted, and presented posters on the following topics:
- Programming the teaching of diagnostic parasitiology: the UK National External Quality Assessment Service (NEQAS) approach (Samual Boadi) http://bit.ly/2GxVd5a
- Results from the 2018 antimicrobial susceptibility testing external quality assessment exercise organised for EARS-Net Participants (Elizabeth Fagan) https://bit.ly/2MamWMX
- UK NEQAS: new external quality assessment scheme fungal biomarkers (galactomannan antigen detection) (Katie Minns) https://bit.ly/2xUdRzr
The poster presentations gave us the opportunity to meet with delegates and potential participants. The program covered a wide range of interesting topics and kept us on the go from early morning (to meet-the-experts) to early evening.
UK National External Quality Assessment Service Microbiology Division Scientific Meeting
Holiday Inn Bloomsbury, Coram St, London
Friday 29th November 2019
We would like to welcome the following new starter
Clare Harris – Project Manager
Cangul Seran- Healthcare Scientist
We wished farewell to the following staff:
Michael Akintunde – Quality Administrator
David Lloyd – Laboratory Support Staff
Shan Lloyd – Quality Manager
Kimberly Pandian – Laboratory Support Staff
Aneta Stranc – Deputy Quality Lead
Anna Williams – Laboratory Support Staff