December 2019 Newsletter

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December 2019 Newsletter

RE-REGISTRATION APRIL 2020 - MARCH 2021

Online re-registration process for 2020 – 2021 for UK participants and overseas laboratories not served by distributors

 

The 2020/21 online re-registration form for UK NEQAS Microbiology will be available through the secure login area of our website from 2nd January 2020.

Participants can review and amend their current participation requirements (please note, if no changes required submission of form is still required) confirming participation requirements for the new financial year.

Once re-registration details have been finalised the form should be submitted via the online portal.

Participants can amend the form multiple times up until the  7th February 2020. Once details  are submitted an option to print or save updated information as a record is advised.

During the re-registration period of 02/01/20 and 07/02/20 participants are encouraged to make any change requests using the online form.

Re-registration for participants with a distributor shall be contacted by their distributor.

Yours sincerely

UK NEQAS Microbiology Operations team

Mycology Teaching Workshop

UK NEQAS for Microbiology have introduced a one-day workshop for healthcare and medical professionals who have limited experience of handling and identifying clinically significant filamentous fungi.

Participation in the UK NEQAS Mycology Teaching Workshop can help increase accuracy of identification skills and confidence in reporting for a range of fungi. This teaching programme is intended to complement the educational aspects of the UK NEQAS for Microbiology Mycology Scheme.

Delegates will have the opportunity to examine fungal cultures and identify characteristics of the isolates via phenotypic and microscopic techniques. The day will encompass clinically significant fungal pathogens including: Aspergillus spp, mucoraceous moulds, dermatophytes and non-dermatophytes.

This course can help delegates interested in learning in depth aspects of fungal infections when attending the 3 day medical mycology programme held in Bristol annually.

Due to overwhelming interest and very positive feedback from the 2017 and 2018 workshops, the one-day workshop will be held again on three separate dates.

Venue: Metropolitan University, London

Dates:  14th, 15th and 16th January 2020.

We are now fully booked!

Please contact organiser@ukneqasmicro.org.uk for details including cost, availability and registration for any of the designated dates for future workshops.

It is strongly recommended to express interest in attendance at annual re-registration (January-February) of our schemes to avoid disappointment.

 

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UK NEQAS Parasitology Teaching Programme

The UK NEQAS Parasitology Teaching Programme organises regional courses in different geographical areas throughout the UKand the Republic of Ireland. The regional venues endeavour to cover the wider areas where our UK NEQAS Parasitology participants are employed. Currently, we use the following locations: Birmingham, Cardiff, Dublin, Dundee, Exeter, London, Preston and Newcastle.
The programme offers an independent one-day practical course covering faecal parasites, designed for Microbiologists and a separate one-day practical course covering blood and tissue parasites, designed for Haematologists.
All of the regional workshops conform to the same delivery format.
Participants are provided with the following as and when needed: Handouts, teaching sheets, bench manuals and pre-prepared slides to take back to their place of work. Guidance is available at all time during the practical microscopy sessions.
The main objective of these courses is to provide both educational and practical support to our participants. Enrolment is through UK NEQAS Microbiology invoicing system.
For further information about the teaching programme and the dates for the workshops for 2020/21 visit: http://parasitologyprogramme.org.uk/

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SCHEME UPDATES

Interpretive Comments scheme

The status of the scheme is now live and UKAS has now assessed this scheme against ISO 17043:2010 (Proficiency Testing schemes) as an extension to scope for UK NEQAS Microbiology; a decision is awaited. By October, 327 participants were registered and there was a mean active participation of 197.

In the last six months we have distributed cases on: influenza treatment & prophylaxis; Pseudomonas aeruginosa in augmented care water samples; primary cytomegalovirus infection; group B streptococcus infective endocarditis; varicella-zoster virus in biological therapy; and Capnocytophaga infection. Twelve out of 17 questions were scored based on a consensus of 80% and five questions were not scored. This scoring ratio is an improvement on the previous period. Performance monitoring will be undertaken after the March 2020 distribution.

In June 2019 participants of the Interpretive Comments Scheme were invited to complete a short survey of ten questions. This survey related to the microbiology/virology interpretive comments scheme distributions in the period April 2018 to March 2019. Participants were invited to take the survey if they had responded to at least three distributions. There were 290 registered participants in June 2019 and 72 (25%) returned answers to the survey. 67 (93%) respondents to the survey were from the UK. The main specialities of the respondents were Medical Microbiology (93%) and Virology (7%). These demographics are very similar to those seen in the previous survey (December 2017). Results are shown below and will be taken into account when moving forward with the scheme.

  1. Topics. 64 (89%) of respondents indicated that the range of topics was ‘about right’; three participants felt it was ‘too wide’ and five that it was ‘too narrow’. Twenty-three respondents made free text comments about the scope of topics. Themes were: 1) that there was too much specialist virology; and that 2) there was too much focus on complex laboratory-orientated topics. A suggestion was to focus on clinical issues faced in daily practice. It is worth noting that this scheme aims to address the needs of both medical microbiologists and virologists, hence the even distribution of cases. Scenarios alternate monthly between those of a virological nature and those of a general bacteriological nature. Parasitology or mycology scenarios are provided periodically; these are at a level that is appropriate to microbiologists who are not specialists in these fields.
  2. Format and detail of case information. 24 (33%) of the participants indicated that the format and detail of the case information were ‘good’, 45 (63%) ‘satisfactory’ and 3 (4%) ‘poor’. Eleven respondents made free text comments about the format/detail of case information. Themes were: 1) that there had been some recent (acknowledged) errors in the distributions; and 2) there could be more clinical information provided. The panel will endeavour to avoid mistakes in the preparation of distributions and to provide all relevant clinical information.
  3. MCQ format. 27 (38%) participants indicated that the format of the questions was ‘good’, 40 (56%) ‘satisfactory’ and five (7%) ‘poor’. Six respondents made free text comments about the format of case information. The common theme was about ambiguity of some of the questions. In order to allow automated scoring ad reporting, the questions have to be in MCQ format. Although Royal College of Pathologists methodology is followed wherever possible in writing questions, it is difficult to think of all possible interpretations and therefore to avoid all ambiguity. The use of questions where there are two intended answers is kept to a minimum, with one intended answer being preferred wherever possible. Similarly, we acknowledge that it is difficult to construct questions where information is revealed as the case progresses, without giving away answers to subsequent questions.
  4. Level of difficulty. The overall level of difficulty of the cases was ‘about right’ according to 68 (94%) participants. One respondent indicated that the level of difficulty was ‘too easy’ and three (4%), ‘too difficult’. Fourteen respondents made free text comments about the format of case information. The main theme arising was variability of the level of difficulty. To some extent this is intentional – the scheme does aim to provide a range of difficulty, both between and within questions. Furthermore, there is no point in all questions being ‘easy’, as this is unhelpful for both EQA and CPD. The scheme is designed primarily for medical practitioners and clinical scientists who are authorised to undertake independent practice in medical microbiology and virology in the UK.
  5. Format of reports. 36 (51%) participants indicated that the format of the reports was ‘good’, 30 (43%) ‘satisfactory’ and four (6%) ‘poor’. Two respondents did not answer this question. Eighteen respondents made free text comments about the format of reports. Two themes arising were: 1) that questions were not always scored; and 2) that the commentaries, while generally good, need to do more to explain (justify) the answers. Most EQA schemes use an agreed level of consensus to determine whether or not to score a question, and this method is approved by the Royal College of Pathologists. While we could set the consensus level higher, many UK NEQAS schemes use 80% consensus for scoring and we find that this works well in practice. Although some participants may be frustrated that they recorded the intended answer, there are many others who would feel hard done to if questions were scored based on <80% consensus. Interestingly, we do aim to provide an explanation for scoring in the commentaries and we clearly need to try harder with this aspect.
  1. Scoring and performance monitoring methods. 25 (35%) participants indicated that the scoring and performance methods (expressed as a run chart with standard deviations around a mean) were good, 38 (54%) indicated satisfactory, 8 (11%) indicated poor and one participant did not respond to this question. Eighteen participants made comments about the methods used for scoring and performance monitoring. The main theme arising was that of uncertainty about how the performance monitoring works, with some concerns expressed about how missed distributions and out of scope distributions might impact upon performance. Participants are able to declare a case to be outside their normal practice (and should be prepared to justify this). To do this, a formal ‘out of scope’ response must be entered on the website within the normal response period; it cannot be entered retrospectively once the distribution has been closed. Participants will not be marked down for declaring a case to be out of scope. By contrast, and in keeping with laboratory UK NEQAS distributions, missed distributions/questions (non-returns) are negatively scored.

Further information on scoring and performance monitoring has been added to the website.

  1. Format of the annual record sheet. Four (6%) participants indicated that the annual record sheet was good and 19 (27%) indicated that it was satisfactory. 46 participants indicated that they did not receive (or recall receiving) this document and one participant did not make a response to this question. The annual record sheet is available to participants who respond to at least 66% of distributions and this can be accessed by clicking on the ‘Lab’ button on the results website and then selecting the report required. This may be used as evidence of participation, e.g. for laboratory accreditation.
  2. Continuing with scoring and performance monitoring

Fifty-five (77%) participants indicated that scoring and performance monitoring should continue, sixteen (23%) that it should stop and one participant did not make a response to this question. Twenty-five participants made comments on continuing with scoring and performance monitoring. Comments were very polarised (before and against) and the main theme arising was around difficulties using the website. We have discussed this with our web development team and they have upcoming improvement plans for this area which will be rolled out in the next 12 months. Overall, participants were clearly in favour of continuing with scoring and performance monitoring.

Thanks are due to all of the people who have helped to draft and peer review cases for the scheme and who have helped with the 2019 survey. These include members of the scheme panel and Shabana Bi at UK NEQAS Microbiology.

Report for Microbiology iEQA scheme, April to September 2019

Scheme status: live

Participation, scoring and consensus:

By October, 327 participants were registered and there was a mean active participation of 197.

Number of questions circulated and scored (table)

12 out of 17 questions were scored (green) based on a consensus of 80%. 5 questions (red) were not scored. This scoring ratio is an improvement on the previous period.

Performance monitoring:

To be undertaken after the March 2020 distribution and results discussed at NQAAP.

Accreditation of scheme:

UKAS has now assessed this scheme against ISO 17043:2010 (Proficiency Testing schemes) as an extension to scope for UK NEQAS Microbiology; a decision is awaited.

Survey of participants 2019 (summary):

In June 2019 UK NEQAS Microbiology invited participants of the Interpretive Comments Scheme to complete a short survey of ten questions. This survey related to the microbiology/virology interpretive comments scheme distributions in the period April 2018 to March 2019. Participants were invited to take the survey if they had responded to at least three distributions. There were 290 registered participants in June 2019 and 72 (25%) returned answers to the survey. 67 (93%) respondents to the survey were from the UK, 3 from Europe and 2 from the rest of the world. The main specialities of the respondents were Medical Microbiology (93%) and Virology (7%). These demographics are very similar to those seen in the last survey (December 2017).

  1. Topics. 64 (89%) of respondents indicated that the range of topics was ‘about right’; three participants felt it was ‘too wide’ and five that it was ‘too narrow’. Twenty-three respondents made free text comments about the scope of topics. Themes were: 1) that there was too much specialist virology; and that 2) there was too much focus on complex laboratory-orientated topics. A suggestion was to focus on clinical issues faced in daily practice. It is worth noting that this scheme aims to address the needs of both medical microbiologists and virologists, hence the even distribution of cases. Scenarios alternate monthly between those of a virological nature and those of a general bacteriological nature. Parasitology or mycology scenarios are provided periodically; these are at a level that is appropriate to microbiologists who are not specialists in these fields.
  2. Format and detail of case information. 24 (33%) of the participants indicated that the format and detail of the case information were ‘good’, 45 (63%) ‘satisfactory’ and 3 (4%) ‘poor’. Eleven respondents made free text comments about the format/detail of case information. Themes were: 1) that there had been some recent (acknowledged) errors in the distributions; and 2) there could be more clinical information provided. The panel will endeavour to avoid mistakes in the preparation of distributions and to provide all relevant clinical information.
  3. MCQ format. 27 (38%) participants indicated that the format of the questions was ‘good’, 40 (56%) ‘satisfactory’ and five (7%) ‘poor’. Six respondents made free text comments about the format of case information. The common theme was about ambiguity of some of the questions. In order to allow automated scoring ad reporting, the questions have to be in MCQ format. Although Royal College of Pathologists methodology is followed wherever possible in writing questions, it is difficult to think of all possible interpretations and therefore to avoid all ambiguity. The use of questions where there are two intended answers is kept to a minimum, with one intended answer being preferred wherever possible. Similarly, we acknowledge that it is difficult to construct questions where information is revealed as the case progresses, without giving away answers to subsequent questions.
  4. Level of difficulty. The overall level of difficulty of the cases was ‘about right’ according to 68 (94%) participants. One respondent indicated that the level of difficulty was ‘too easy’ and three (4%), ‘too difficult’. Fourteen respondents made free text comments about the format of case information. The main theme arising was variability of the level of difficulty. To some extent this is intentional – the scheme does aim to provide a range of difficulty, both between and within questions. Furthermore, there is no point in all questions being ‘easy’, as this is unhelpful for both EQA and CPD. The scheme is designed primarily for medical practitioners and clinical scientists who are authorised to undertake independent practice in medical microbiology and virology in the UK.
  5. Format of reports. 36 (51%) participants indicated that the format of the reports was ‘good’, 30 (43%) ‘satisfactory’ and four (6%) ‘poor’. Two respondents did not answer this question. Eighteen respondents made free text comments about the format of reports. Two themes arising were: 1) that questions were not always scored; and 2) that the commentaries, while generally good, need to do more to explain (justify) the answers.  Most EQA schemes use an agreed level of consensus to determine whether or not to score a question, and this method is approved by the Royal College of Pathologists. While we could set the consensus level higher, many UK NEQAS schemes use 80% consensus for scoring and we find that this works well in practice. Although some participants may be frustrated that they recorded the intended answer, there are many others who would feel hard done to if questions were scored based on <80% consensus. Interestingly, we do aim to provide an explanation for scoring in the commentaries and we clearly need to try harder with this aspect.
  1. Scoring and performance monitoring methods. 25 (35%) participants indicated that the scoring and performance methods (expressed as a run chart with standard deviations around a mean) were good, 38 (54%) indicated satisfactory, 8 (11%) indicated poor and one participant did not respond to this question. Eighteen participants made comments about the methods used for scoring and performance monitoring. The main theme arising was that of uncertainty about how the performance monitoring works, with some concerns expressed about how missed distributions and out of scope distributions might impact upon performance. Participants are able to declare a case to be outside their normal practice (and should be prepared to justify this). To do this, a formal ‘out of scope’ response must be entered on the website within the normal response period; it cannot be entered retrospectively once the distribution has been closed. Participants will not be marked down for declaring a case to be out of scope. By contrast, and in keeping with laboratory UK NEQAS distributions, missed distributions/questions (non-returns) are negatively scored.  Further information on scoring and performance monitoring has been added to the website.
  1. Format of the annual record sheet. Four (6%) participants indicated that the annual record sheet was good and 19 (27%) indicated that it was satisfactory. 46 participants indicated that they did not receive (or recall receiving) this document and one participant did not make a response to this question. The annual record sheet is available to participants who respond to at least 66% of distributions and this can be accessed by clicking on the ‘Lab’ button on the results website and then selecting the report required. This may be used as evidence of participation, e.g. for laboratory accreditation.
  2. Continuing with scoring and performance monitoring  Fifty-five (77%) participants indicated that scoring and performance monitoring should continue, sixteen (23%) that it should stop and one participant did not make a response to this question. Twenty-five participants made comments on continuing with scoring and performance monitoring. Comments were very polarised (before and against) and the main theme arising was around difficulties using the website. We have discussed this with our web development team and they have upcoming improvement plans for this area which will be rolled out in the next 12 months. Overall, participants were clearly in favour of continuing with scoring and performance monitoring.

Bacteriology Schemes

December 2019 brings changes to the Bacteriology schemes, with Paul Chadwick stepping down from his part time role as the interim Scheme Organiser and the full time appointment of Jennifer Henderson as the new Scheme Organiser for Bacteriology and Mycology. Paul will continue as Scheme Organiser for Interpretive Comments. We hope and expect that these changes will continue to allow UK NEQAS Microbiology to promote and develop all of these schemes moving forward.

In this section of the newsletter we will focus on the Antimicrobial Susceptibility scheme, where many changes have now started to take place. Twelve distributions are prepared and dispatched each year to over 600 UK and non-UK clinical diagnostic laboratories. For each distribution, two isolates are prepared and distributed and participants undertake AST (antimicrobial susceptibility testing) and reporting. The specimens contain potential pathogens that are fully characterised, with antimicrobial susceptibilities, and correspond to those likely to be found in clinical practice. Following the close of the distribution, a report is written to summarise the guidelines (EUCAST, CLSI) used by participants and the results obtained, so that participants can assess their individual performance and compare this to results obtained by aggregated participants. More than 80% of our participants tell us that they now use EUCAST methods to determine AST results. Expert comments accompany  the reports with additional comments on methods used and findings in relation to the resistance genes present in the isolates. We are aware that participants find these expert comments very useful and we apologise that there is currently a long delay in adding these to the reports. This will be remedied in the near future and expert comments will be added to the 2019 reports.

Participants will be pleased to hear that a stringent series of quality control checks is undertaken,  from the preparation of specimens to the dispatch of the distributions.  In order to assess effects of transportation, panels are dispatched to five national  centres, who return them to the UK NEQAS laboratory for us to check the viability and homogeneity of the organisms. Two reference laboratories provide MIC data obtained by broth microdilution and one reference laboratory provides whole genome sequencing (WGS) data to characterise all known resistance genes within isolates.

We receive many queries about scoring of this scheme. Note that EQA is an educational process which challenges the total quality system. Within this, trends are more important than individual results, and so while it is important to review and investigate all results where a full score is not achieved, it is the overall performance in the scheme that is most important. Scoring is based on a straight 80% consensus of participants (and must be in agreement with reference laboratories’ MIC results). The current version of EUCAST/CLSI is used. Scoring rules are published on the UK NEQAS website, and include scenarios where results differ between EUCAST and CLSI guidelines, or where only one of these committees provides an interpretation. Unfortunately we cannot determine why an individual participant/laboratory has been unsuccessful in obtaining the intended results by their stated guideline/method (although we are regularly asked to do so!). Following an incorrect result, participants should review all aspects of their AST in terms of media, inoculum, incubation time and temperatures, and storage conditions (both reagents and specimens) etc.

Clinical sites other than blood have now been introduced , which allows new antimicrobial agents to be tested by participants, for example AST for oral agents. Identification of organisms is now provided, as other schemes (such as the general bacteriology scheme) test characterisation of organisms.

Area of technical uncertainty (ATU) is new for 2019 from EUCAST and is potentially an issue for EUCAST users. However, the scoring depends upon MIC results from reference laboratories (not individual participants’ results). So far, ATU has not been applicable to the scheme, and when reference laboratory results do fall into the ATU, the results will probably not be scored. Another area that we have received queries about is the clinical interpretation of results that fall into the ‘intermediate’ category. This issue is also new in 2019 for EUCAST users. In effect, the clinical interpretation may change, so that the ‘I’  (intermediate) category is now susceptible, rather than resistant. Although participants may suppress or change interpretations, the ‘S’ (susceptible) , ‘I’ (intermediate) and ‘R’ (resistant) AST categories will continue to be requested of participants as test results in accordance with EUCAST/CLSI methods and so far this issue has not affected scheme results or scoring decisions.

The following organism/agent combinations have recently caused difficulties for participants:

Distribution 4270 (April 2018)

  1. Specimen 4347 was an Escherichia coli resistant to amoxicillin and ampicillin, and with reduced susceptibility to amoxicillin-clavulanate. WGS showed the presence of the blaTEM-1 gene encoding the TEM1 beta-lactamase. Typically, this enzyme confers resistance to aminopenicillins and is inhibited by clavulanate. However, this organism had reduced susceptibility to amoxicillin-clavulanate. The MIC for amoxicillin-clavulanate was 16 mg/L, which was resistant by EUCAST (S≤8, R>8) and intermediate by CLSI criteria (S≤8, R≥32). Performance was poor with only 42.5% of EUCAST users and 17.9% of CLSI users reporting reduced susceptibility. There was little difference in performance across different testing methods. Poor performance was probably due to the closeness of the organism MIC to the breakpoints, and the inherent difficulties in testing beta-lactam/beta-lactamase combinations.

Distribution 4283 (May 2018)

  1. Specimen 4391 was a multi-resistant Escherichia coli. WGS indicated the presence of genes encoding multiple beta-lactamases, including TEM-1, CTX-M-15, and OXA-1. The combination of these enzymes resulted in resistance to penicillins, cephalosporins, beta-lactam/beta-lactamase combinations and ertapenem. WGS also indicated the presence aac(3)-IIa, aac(6′)-Ib-cr, aadA2 and aph(3′)-Ia encoding aminoglycoside modifying enzymes, resulting in reduced susceptibility to amikacin, gentamicin, and tobramycin. For amikacin, the MIC was 32-64 mg/L. This was resistant by EUCAST (S≤8, R>16), but intermediate or resistant by CLSI criteria (S≤16, ≥64). Only 31.4% of EUCAST users correctly reported a resistant result, and only 55.4% of CLSI users reported the isolate as I/R; there was no significant difference in performance between methods used. Poor performance may have been due to the fact that the aac(6’)-I enzyme may not confer phenotypic resistance despite modification of amikacin. EUCAST users will be aware that there is an expert rule (12.7) that attempts to account for this issue, but the problem was confounded by the presence of a multiple aminoglycoside modifying enzymes.

Distribution 4297 (June 2018)

  1. Specimen 4430 was a Streptococcus pneumoniae from CSF with reduced susceptibility to penicillin and 3rd generation cephalosporins. The organism had a reference MIC of 2-4 mg/L for penicillin which, for meningitis, was resistant by both EUCAST (S≤0.06, R >0.06), and CLSI criteria (S≤0.06, R≥0.12). Performance was excellent for penicillin, with 98.4% of participants recording a correct resistant result. The reference MICs for cefotaxime and ceftriaxone were 2 and 1 mg/L which, using appropriate criteria for CSF/meningitis isolates was intermediate by EUCAST (S≤0.5, R >2), and I/R by CLSI criteria (S≤0.5, R≥2). For participants using EUCAST criteria, <50% of participants reported reduced susceptibility to 3rd generation cephalosporins. Automated systems performed better than disk diffusion or MIC methods.

Distribution 4314 (July 2018)

  1. Specimen 4480 was a Staphylococcus aureus. WGS indicated the presence of both the ermA and ermC genes, encoding RNA methylases that alter the target site for erythromycin and clindamycin. The isolate was resistant to penicillin (WGS showed the presence of the gene for the typical staphylococcal beta-lactamase), but sensitive to meticillin. 4% of participants reported a correct sensitive result for cefoxitin, but only 53.8% of participants reported a correct sensitive result for oxacillin. The performance of automated systems was poorer than disk testing for both cefoxitin and oxacillin, with performance being particularly bad for oxacillin; only 43.0% reported a correct sensitive result.

Distribution 4328 (July 2018)

  1. Specimen 4527 was a Klebsiella pneumoniae. WGS indicated the presence of the blaSHV-5 gene encoding the SHV-5 ESBL, conferring resistance to cefuroxime, cefotaxime, ceftriaxone, ceftazidime, and beta-lactam inhibitor combinations. More than ninety-nine per cent of participants correctly identified the presence of an ESBL and correctly reported the isolate as resistant to the cephalosporins. However, performance was poor for amoxicillin-clavulanate and piperacillin-tazobactam; testing is often challenging when testing ESBL-producing isolates against such agents. For amoxicillin-clavulanic acid, the isolate had an MIC of 32-64 mg/L and was resistant by both EUCAST (S≤8, R>8) and CLSI (S≤8, R≥32) breakpoints. The isolate had an MIC of >64 mg/L for piperacillin-tazobactam, and was resistant by EUCAST (S≤8, R>16), and intermediate by CLSI (S≤16, R≥128) breakpoints. For EUCAST users, 73.7% of participants correctly reported resistance for amoxicillin-clavulanic acid and there was no performance difference between methods. For piperacillin-tazobactam, 68.7% of EUCAST users correctly reported resistance, but the performance of disk testing was significantly worse, with only 35.5% of EUCAST disk users reporting a correct result. For piperacillin-tazobactam, only 19.0% of CLSI users reported a resistant result for amoxicillin-clavulanic acid, and only 42.1% reported an intermediate result for piperacillin-tazobactam.

Distribution 4342 (August 2018)

  1. Specimen 4571 was an Enterobacter cloacae complex which was resistant to all of the reference agents tested except colistin. WGS indicated the presence of genes encoding multiple beta-lactamases, including, TEM-1, CTX-M-15, OXA-1, CMY (a mobile AmpC-type beta-lactamase) and NDM-1. There were also three genes (aac(3)-IIa, aac(6′)-Ib-cr, aadA1) encoding aminoglycoside modifying enzymes. 9% of participants correctly identified the presence of a carbapenemase, while 28.0% and 33.3% reported the presence of an ESBL or an AmpC respectively. This isolate shows the difficulty of detecting some specific beta-lactamases phenotypically when there are multiple enzymes present, particularly a carbapenemase.

Analysis of organism/agent combinations for which participants/laboratories performed poorly does not suggest any overall advantage of using automated, MIC or disk methods.

Finally, we anticipate further new developments with the antimicrobial susceptibility scheme. These will include a change the report format, which in future will no longer illustrate graphs of zone diameters , but will include charts illustrating a method breakdown and additional information on MIC methods to include data on broth dilution vs gradient diffusion methods (where we have recently noted some discrepancies).

Thanks are due to all of the people who have helped to prepare and distribute cases for our schemes in Bacteriology and Mycology. These include Shila Seaton, Liz Fagan, staff at UK NEQAS Microbiology and our expert advisors for the Antimicrobial Susceptibility and Mycology schemes.

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What's new?

UK NEQAS 50th Anniversary Consortium 20-21 November Birmingham, UK

UK NEQAS Consortium turned 50 this year and hosted a series of events to celebrate this milestone, amongst them its first  pan- disciplinary event, held on 5 November, Dublin, Ireland which was sold out and deemed a success.

Mr. Liam Whitby, President, UK NEQAS Charity

This years’ UK NEQAS Consortium event (held annually for UK NEQAS staff across its Centres) celebrated this ‘golden’ milestone with a series of talks (over two days) by current and past presidents of UK NEQAS, Scheme Organisers/Directors and other guest speakers, reflecting the birth of the first EQA programmes  in 1969.

Archives of publications highlighted the efforts of pioneer scientists (Dr Mitchell Lewis – haematology and Professor Tom Whitehead- chemistry) and looked at their prestigious legacy to-date. The plethora of presentations highlighted the foresight of examining performance of laboratories and comparison of results through an independent evaluation and even though it was initially envisaged as a short term service (funding provided for 2-3 years) the need for assessment through EQA continued to prove invaluable.  The need for evaluation and education continues to exist till this day with UK NEQAS presently delivering 358 programmes!

The talks also looked ahead to what the service can provide into the next 50 years with challenges on re-organisation of pathology services , changing diagnostics and automation, rapid tests

Past and Present staff

The celebrations brought together staff currently working within their respective centres and special guests compromising of previous staff whom had contributed significantly to the service. It was a great opportunity to reminisce, catch up and celebrate all the achievements provided by the service in the UK and internationally

UK NEQAS for Microbiology – Then and Now

Julie Russell reflects on the origins of UK NEQAS for Microbiology

In 1966 a young microbiology technician joined the team at the Central Public Health Laboratory in Colindale that was responsible for operating the National Collection of Type Cultures (NCTC). That technician was Jerry J.S. Snell who arrived at a time when NCTC was still providing a pathogen identification service for unusual or difficult to identify bacteria isolated in clinical microbiology testing laboratories.

There was some consternation within the NCTC team about the quality of the preliminary test results provided with the isolates that were being submitted for identification. This led the team to dispatch panels of NCTC isolates to clinical diagnostic laboratories to test their proficiency with basic microbiological examinations.

Jerry Snell organised these dispatches with Dr P.B. Crone and the subsequent assessment of the results reported by the testing laboratories on behalf of NCTC; by1972 these were recognised as the first distributions of UK NEQAS for Microbiology. In 1976 a small team, with Dr Crone at the helm, left NCTC for a separate unit that was dedicated to delivering the UK NEQAS schemes. When Dr Crone left the department Jerry Snell became the Scheme Organiser for UK NEQAS for Microbiology and we are proud that the schemes are going strong 48 years later, albeit more far-reaching and complex than ever before, as the clinical environment and associated technologies change and emerging and re-emerging pathogens continue to impact on people’s health.

In addition to becoming an essential part of laboratory testing by allowing laboratories to demonstrate the quality of the test results they provide, and an invaluable source of education for participating laboratories, UK NEQAS EQA specimens and results continue to be used worldwide in scientific projects. Recent examples include a comparison of the analytical performances of two assays for detecting Chlamydia trachomatis and Neisseria gonorrhoea by a team in Switzerland1 and the molecular characterization of carbapenem-resistant Escherichia coli and Acinetobacter baumannii in the Lao People’s Democratic Republic2.

If your laboratory publishes studies that have involved UK NEQAS specimens or results please let us know so we can feature your studies in our future newsletters.

Although Jerry Snell retired some years ago, our more recently appointed Organisers strive to continue his legacy, providing UK NEQAS schemes and associated training that help to ensure microbiology results for patients’ specimens are always accurate and correctly interpreted.

1https://www.microbiologyresearch.org/content/journal/jmm/10.1099/jmm.0.000909

2 https://ora.ox.ac.uk/objects/uuid:ab0373ed-975b-43fc-9d99-9fd186af921e/download_file?file_format=pdf&safe_filename=Cusack%2BCarbapenem%2Bresistance%2BJAC%2B2019.pdf&type_of_work=Journal+article

Jerry Snell, Pancake Day 23rd Feb 1982

My Lab – Examinations of Parasitology

By Agatha Saez, Healthcare Scientist Specialist, UK NEQAS Parasitology

UK NEQAS Parasitology has been operating since 1986. It is a member of the UK NEQAS Consortium – a not-for-profit company and a UK-registered charity, which is this year celebrating its 50th anniversary. We provide international external quality assessment (EQA) or proficiency testing for clinical laboratories, blood banks, point-of-care testing centres and other testing sites that carry out examinations in parasitology. Various methods, including microscopic identification, serology, point-of-care and molecular testing, are catered for. Specimens are designed to simulate clinical samples and allow participants to assess their routine assays and practices. The schemes we offer are accredited for ISO/IEC 17043:2010.

We are hosted by Public Health England and operate from the premises of the Halo building in London.

We run seven parasitology EQA schemes and have at least two more in the development phase. We offer a range of techniques and sample layouts covering several parasites and techniques for detection. The range of parasites in the faecal specimens includes protozoan cysts, helminth ova, larvae and oocysts. While in the blood parasitology distributions, we include malaria parasites, microfilariae, trypanosomes and Leishmania. We also offer detection of malaria antigen, malaria nucleic acids, parasite serology and Toxoplasma serology. In addition to EQA provision, teaching programmes are also available for both blood and faecal parasites. Our department is led by Professor Peter Chiodini, the Scheme Organiser. Other team members are: Dr Jaya Shrivastava, the Scheme Manager, Dr Samuel Boadi, the Teaching Manager, myself as Healthcare Scientist Specialist, and Ms Nikita Chauhan as the Laboratory Support Staff.

I have over 20 years of experience in clinical parasitology. I joined the team in 2004 as Laboratory Support Staff and, through various promotions, have grown within the team to my present role of Senior Healthcare Scientist. My main duties are: preparation, evaluation and internal quality control of EQA specimens for our schemes and I achieve this by applying knowledge of clinical parasitology to the design, quality control and stability of these specimens. I also help set up collaborations and field visits to the Philippines to source faecal and blood parasites. Additionally, I help with data entry, the preparation of participants’ performance reports and any accompanying teaching sheets.

We are a high-performing team and pride ourselves on the quality of service that we offer to all our participants. To this effect, our work has recently been recognised via the “RCPath Excellence Awards for 2019” which exemplifies the best of pathology practice. We won the award under the Excellence in Education category. More recently, I won the best poster award at the recent IBMS Congress 2019, for presenting findings from our faecal parasitology scheme.

Shila Seaton, Scheme Manager for the UK NEQAS Schemes for Bacteriology/Mycology, focuses on the important educational aspect of UK NEQAS, highlighting her own and Scheme Organiser Jen Henderson’s contribution to ‘Tutorial Topics in Infection’

Publications – Tutorial Topics In Infections 

UK NEQAS objectives are primarily educational (delivered through EQA and teaching programmes/ workshops). Staff have specialisms that contribute towards these educational objectives, with mine being in mycology and I would very much like to share my experience of diagnostic medical mycology with all who are interested in this specialist field.

I have gained over 23 years’ experience and a sheer passion for diagnostic medical mycology, (I love the filamentous ones)  whilst leading the mycology discipline at the Royal Free NHS Trust and conducting research into the molecular and serological diagnosis of fungal infections.

I have continued my interest at UK NEQAS, and was invited to write a chapter on Tutorial topics of Infections— Fungal Diagnostics.

Jennifer Henderson our newly appointed Scheme organiser has also contributed to a chapter on Bacteriology diagnostic methods whilst employed at St. Barts Hospital

The book is available in paperback and on line, and covers all the disciplines in Medical microbiology.

The book comprises of short concise chapters and a self-assessment exercise at the end of each topic, an ideal source for medical professionals

This book was shortlisted for the British Medical Association awards and is published by Oxford Press available in hardback and online

The authors are international experts in their fields, from the UK, Europe, North and South America, Asia and Australia. This book is aimed at microbiologists, research scientists, infectious diseases clinicians, respiratory physicians, and those managing immunocompromised patients, as well as mycology course students and trainees in medical microbiology and infectious disease

I have co-authored the chapter on EQA and biosafety, to highlight the awareness to mycology laboratories of the importance of bio-safety when handling hazard group 2 and hazard group fungal organisms and emphasis on the importance of participating in an EQA , an integral component of a robust quality management system.

Enjoy reading

NCTC 100 Anniversary Logo RGB

The National Collection of Type Cultures (NCTC) is one of the longest established collections of microorganisms in the world; its cultures reflect the history of clinical bacterial infections from the end of the 19th century to the present day. Set up in 1920 to “provide a trustworthy source of authentic bacteria for use in scientific studies”, the remit for NCTC has remained essentially unchanged. There are currently around 6000 type and reference strains in the collection, representing over 1000 different bacterial species with deposits coming from a variety of sources including individual collections, the research community, PHE reference laboratories, and from national collections from around the world.

 

In 2020, NCTC celebrates 100 years of collaborating with bacteriologists from around the globe. To start the celebrations NCTC will be holding a one-day symposium on 2 March 2020 to commemorate the history of the collection, its curators and depositors, and to highlight the varied uses of NCTC strains and strain genome data. The symposium, held Public Health England, Colindale, London will provide a forum for scientists to discover of the historical importance of NCTC as biological resource centre and its current role supporting and promoting global health.

 

Registration for this event will open shortly. For more information on this, and all NCTC centenary events throughout 2020, sign-up to receive NCTC newsletters, news and events emails www.phe-culturecollections.org.uk/signup and follow NCTC on Twitter @NCTC_3000

 

UK & INTERNATIONAL MEETINGS

Pan UK NEQAS meeting Dublin (5th Nov 2019)

This meeting the first as a joint collaboration between the different UK NEQAS Centres to celebrate the 50th anniversary of UK NEQAS. The meeting was fully booked with more than 150 delegates.

Presentations were held from various UK NEQAS Centres, with a microbiology case study presentation by Sanjiv Rughooputh which incorporated the history of UK NEQAS Microbiology EQA with the launch in 1971 of the General Bacteriology scheme and its evolution the last 48 years. It was an opportunity to highlight the flexibility of the different schemes (such as compatibility with MALDI-ToF, POCT devices) and the added value of expert commentaries in the different reports such as the antimicrobial susceptibility, mycology and antifungal susceptibility.

The first meeting was deemed a success by those whom attended:

IBMS congress stand 24th – 25th September 2019

Our Virology Scheme Organiser, Sanjiv Rughooputh, attended this years’ IBMS congress on the 24th and 25th September 2019, where UK NEQAS had a stand. The stand served as a point of contact for existing and potential participants of the service as well as to assist the delegates attending with any of their EQA queries and to promote new EQA services. There was interest for of point-of-care schemes for influenza and RSV detection. The Congress runs many parallel sessions across all pathology disciplines and is a chance to meet and collaborate across these disciplines. In addition to the stand,  UK NEQAS Microbiology had  posters displayed at the Congress looking at:

‘Review of the first year of the HEV serology EQA scheme’

and award-winning posters for  ‘Determining the stability of 16S rRNA N. gonorrhoeae in simulated urine EQA samples’ and Review of EQA specimens containing multiple faecal parasites- a 3 year analysis’

First year review of the HEV EQA serology scheme

My name is Muna Jama and I’m a healthcare scientist UK NEQAS Microbiology. I presented a poster about our HEV EQA scheme at the IBMS conference.

I received a lot of compliments and feedback about my poster a lot of which I have shared with my fellow colleagues.

Going to the IBMS conference increased my knowledge as I had a chance to interact with fellow delegates and exchange knowledge about science and development in the laboratory.

I have also had the opportunity to meet kit manufacturing companies and was able to witness the newest and most current tests that are available in the market.

Review of EQA specimens containing multiple parasites: a three-year analysis

Agatha Saez won the first prize for poster at IBMS congress 2019. The IBMS website states: The calibre of entries was extremely high and only the best made it onto the walls.

 

 

 

 

 

Congratulations Agatha!

Workshop in collaboration with Biognostica 22nd – 23rd October 2019

A  workshop was organised jointly by UK NEQAS for Microbiology and Biognostica (Portuguese distributor)  in Portugal in October in Lisbon and Porto celebrating  the 50th anniversary of UK NEQAS Consortium and 20th anniversary of Biognostica and was an opportunity to engage with Portuguese participants. Presentations were given by Antonio Teixeira, Director of Biognostica) and from Scheme Organiser for bacteriology, Paul Chadwick, Scheme Organiser for virology Sanjiv Rughooputh and Parasitology Teaching Manager, Samuel Boadi whom between them presented on aspects of work conducted in Microbiology and Parasitology. Each venue attracted approximately 70 participants and feedback highlighted the importance of multi-analyte schemes and expert commentary in reporting and looking ahead to future developments.

Pathology week at Broomfield’s Hospital  8th Nov 2019.

Natasha Bundock (Healthcare scientist specialist) and Sanjiv Rughooputh (Scheme Organiser for Virology) took part in  National Pathology week at the Broomfield hospital, Essex.  The UK NEQAS stand was there to explain about concepts of EQA and a presentation was given to an audience of laboratory staff, hospital staff (including clinicians) and visitors.

UK NEQAS SCIENTIFIC MEETING 2019

UK National External Quality Assessment Service Microbiology Division Scientific Meeting:
"Improving Patient Outcomes in Infection Matters to Us"

Placement student: Louise Twi-Yeboah

The UK NEQAS Microbiology team were very happy to welcome participants to a day themed around Improving Patient Outcomes in Infection. There were six external speakers and talks from several staff from within the UK NEQAS consortium. The meeting was chaired by Rohini Manuel (current chairperson for UK NEQAS for Microbiology steering committee) and Alan Noel.

 

Past, present and future challenges for infection management in Primary Care, Alastair Hay, University of Bristol

 

Talk described key challenges including determining the nature of infection, narrowing it down to bacterial or viral, as well as, the effect of administering antibiotics on antibiotic resistance. Trials have been run, using point-of-care testing to attempt to establish when antibiotics should be used to fight a particular infection. This form of point of care testing has been shown to change the practitioner’s perception of the use of antibiotics to fight infections.

Clinical evidence and practical experience in the management of invasive fungal infections, David Enoch, Public Health England

In a talk about the management of invasive fungal infections, the importance of antifungal stewardship in reducing costs, side effects and limiting the emergence of fungal resilience was described. In-house identification and susceptibility testing are significant aspects of decreasing mortality occurring due to anti-fungal resistance.

Antimicrobial resistance, Richard Puleston, Public Health England

Antimicrobial resistance as a key and urgent problem was addressed by Richard Puleston. A wide range of factors contribute to antimicrobial resistance, including poverty, poor sanitation and inappropriate use of antibiotics. Surveillance is used to reduce incidents and as an early warning system for emerging cases of resilience.

Emerging infectious diseases, Gee Yen Shin, University College London Hospitals NHS Foundation Trust

The talk on emerging infectious diseases by Gee Yen Shin depicted how language and lack of understanding of diseases can be used to induce panic amongst the public. Often what is considered as emerging infectious diseases are in-fact re-emergent diseases which have increased in occurrence and become a serious threat to public health. The Ebola virus is a notable and recent example, as it was discovered in 1976 but was the cause of a recent outbreak in 2014-16, West Africa.

An overview of UKAS Assessment of POCT providers to ISO 15189:2012/ISO 22870:2016 Standards,
John Ringrow, UKAS

The talk described how pathology testing outside of laboratories are regulated to provide high quality care. The ISO 22870:2016 standards for Point of Care can be accredited additionally to the ISO 15189:2012 Standards which govern medical laboratory practice. This standard allows laboratories to widen their scope of application to include point of care testing.

UK NEQAS: another 50 years, Barbara De la Salle, UK NEQAS Haematology

The future of UK NEQAS appears to be moving towards a more automated, direction which may be more inclusive of various forms of technology. We can except to see an increase in automated interactions for gathering data and processing of audits. Currently UK NEQAS Haematology and UK NEQAS Immunology, Immunochemistry and Allergy (IIA) are evaluating a pilot for UK NEQAS Clinical Chemistry where direct data submission is being used with the aim of improving logistical management.

I was lucky enough to attend the UK NEQAS user day during the UK NEQAS 50th anniversary. There were many notable talks during the day and I was able to learn about a variety of topics surrounding microbiological testing and regulations.

GOOD NEWS

After recently joining UK NEQAS as the Scheme Organiser for Bacteriology and Mycology I look forward to embracing my new role and the challenges that lie ahead. I am originally from a diagnostic background and have worked in various microbiology laboratories across Peterborough, Brighton, Basildon and London prior to making the leap into the world of External Quality Assessment.

I hold over ten years of experience with specific responsibilities relating to modernisation & development. I also have a keen interest in research, which has led me to pursue a Professional Doctorate in Biomedical Science, looking into the prevalence and management of carbapenemases within a hospital setting. I hope to utilise these skills to keep abreast of the ever changing field of microbiology and develop future schemes which will most benefit our participants.

Opportunities to meet UK NEQAS staff

We will be attending the following national and international conferences and would be delighted to meet, say hello and answer any queries  you may have

  • ECCMID which will take place in Paris, France, 18-21 August 2020
  • UK NEQAS Scientific Meeting- 27th November 2020, Central London, UK

Further details will also be available on our Twitter feed @UKNEQASMicro

We would like to welcome the following new starters

Cangul Seran – Healthcare Scientist

Danielle Mack – HCS Production Supervisor

Jennifer Henderson – Bacteriology Scheme Organiser

Juma Akhtar – Healthcare Scientist Associate

Li Sa Choo – R&D Healthcare Scientist

Louise Twi-Yeboah – Placement student

Marit Orav – HCS Team manager (Virology & Bacteriology) 1-year FTC

Mohammed Islam – Healthcare Science Support Staff

Pratima Mahajan – Quality Manager

We wished farewell to the following staff:

Beatrix Kele – Virology Scheme Organiser

Clare Harris – Project Manager

Diana Southern – Healthcare Scientist

Hanika Bhanderi – Healthcare Scientist

 

We would like to send Katie Minns our best wishes who will be on Maternity leave until September 2020

Please contact our Operations team if you have any customer queries on: organiser@ukneqasmicro.org.uk