August 2021 Newsletter

August 2021 Newsletter

UK NEQAS GOLD

Celebrating our 50th Anniversary

For our 50th celebrations we have distributed souvenirs to all our participants and distributors.

Thank you for your continued support!

UK NEQAS Webinars

UK NEQAS for Microbiology successfully delivered six virtual, free-to-attend webinars via Zoom. Participation came from all over the world and the positive feedback has been overwhelming. We are delighted that so many of you were able to attend and requested recordings to the presentations.

If you were not able to attend the live event, all recordings are available on our website to watch at your leisure.

Session 1: How to Handle the EUCAST New Definitions of S, I & R
Date: Thursday 13th May 2021 | Speaker: Professor Gunnar Kahlmeter |
Expert Panelist: Dr Mandy Wootton
EUCAST (The European Committee on Antimicrobial Susceptibility Testing) recently changed the definitions of S, I and R in susceptibility testing. As part of the change, ALL breakpoints were reviewed and in several instances revised to ascertain that breakpoints (and thus susceptibility testing results) match the new definitions and the relevant dosing and administration. The webinar will explain and encourage discussion of the recent change.

Session 2: EQA for Covid-19; Emerging Technologies and Forward Planning in an Unpredictable Environment
Date: Thursday 27th May 2021 | Speaker: Melanie Smith | Expert Panelist: Melanie Amphlett
A review of Covid testing technologies and quality assurance from the beginning of the pandemic to present day. The Covid-19 pandemic has seen a revolution in diagnostic technology to meet the changing priorities of the pandemic phases. Melanie discussed the phenomenal behind-the-scenes activities that have taken place to provide testing technologies and quality assurance for tests that are in-use for primary diagnosis in acute care, for containing infection and to enable society. These tests are provided by public and private healthcare providers. Rapid change and implementation is not without challenge and risk, NEQAS has flexibly supported the development of quality assurance materials to support the changing testing environment.

Session 3: The Evolution of Interpretive Comments in Infection
Date: Thursday 17th June 2021 | Time: 14:30-15:30 (UK) | Duration: 60 minutes
Speaker: Dr Paul Chadwick | Expert Panelist: Dr Rohini Manuel | Host: Dr Jennifer Henderson
This talk outlined the development of the UK NEQAS Interpretive Comments scheme and demonstrate how this has changed and modernised in recent years. The talk explained how scoring and performance monitoring is achieved and showed to what extent the scheme aligns with the Royal College of Pathologists on interpretive EQA. Questions from the scheme will be used to illustrate content and functionality.

Session 4: New Drugs for New Bugs
Date: Wednesday 23rd June 2021 | Time: 14:30-15:30 (UK) | Duration: 60 minutes
Speaker: Dr Mandy Wootton | Expert Panelist: Dr Katie Hopkins | Host: Dr Jennifer Henderson
The session highlighted the mode of action, susceptibility testing and resistance to some of the newer agents to come on to the market for treating MDR Gram-negative bacteria. With EUCAST breakpoints published recently, this will guide users on how to read and interpret susceptibility testing.

Session 5: Laboratory Diagnosis of Diphtheria and Related Infections
Date: TBC | Time: 14:30-15:30 (UK) | Duration: 60 minutes |
Speaker: Professor Androulla Efstratiou | Expert Panelist: Dr Mark Muscat | Host: Dr Jennifer Henderson
This presentation will feature the disease diphtheria, some epidemiological and microbiological aspects but focus primarily upon laboratory diagnostics.

Session 6: Detection of Carbapenemase-Producing Gram-Negatives
Date: Thursday 22nd July 2021 | Time: 14:30-15:30 (UK) | Duration: 60 minutes
Speaker: Dr Katie Hopkins | Expert Panelist: Daniele Meunier | Host: Dr Jennifer Henderson
Gram-negative bacteria (especially Enterobacterales) producing acquired carbapenemases are an urgent public health threat due to limited treatment options. This presentation gave an overview of the phenotypic and genotypic laboratory methods available for their detection.

PILOT UPDATES

UK NEQAS for Microbiology: SARS-CoV-2 antigen EQA

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). According to the World Health Organization (WHO) Coronavirus Disease (COVID-19) Dashboard, SARS-CoV-2 has caused over 187 million confirmed COVID-19 cases globally and over 4 million associated cause of death by 15th July 2021.  This rapid spread and increase in number of new cases is due to person-to-person transmission.

To control the transmission of SARS-CoV-2, early laboratory diagnosis of both asymptomatic and symptomatic patients is crucial. Reverse transcription polymerase chain reaction (RT-PCR) to detect SARS-CoV-2 viral RNA in patient samples is considered as the gold standard, but the sheer volume of testing required has caused bottlenecks in diagnostic capabilities in laboratories worldwide. Methodological simplification could increase diagnostic availability and efficiency, benefitting patient care and infection control.

New tests for SARS-CoV-2 are being developed and rolled out to cope with this demand with one of the tests being deployed for mass testing being SARS-CoV-2 antigen test.

Antigen tests are widely used to diagnose respiratory pathogens such as influenza viruses and respiratory syncytial virus and recently the U.S. Food and Drug Administration (FDA) has granted emergency use authorisation (EUA) for antigen tests that can identify SARS-CoV-2.

Antigen tests for SARS-CoV-2 are generally less sensitive than RT-PCR and other nucleic acid amplification tests for detecting the presence of viral nucleic acid. Proper interpretation of the antigen test results is therefore important for accurate clinical management of patients, people with suspected COVID-19, or for identification of infected people during screening, especially as most antigen tests are performed outside laboratory settings.

To provide confidence in the results produced by these tests and also to monitor the performance of institutions offering antigen testing, UK NEQAS for Microbiology launched a SARS-CoV-2 antigen external quality assessment (EQA) scheme in June 2021, after successfully completion of 2 pilot studies in February and March 2021. The scheme consists of 6 distributions of 4 specimens. The specimens simulate nasopharyngeal swabs. The scheme is suitable for point of care settings and also for any organisation testing for SARS-CoV-2 that do not have conventional laboratory settings.

The SARS-CoV-2 specimens are non-infectious and hence suitable to be handled outside the conventional laboratory settings. Participants are allowed to return results for up to 2 methods they use.

In the first pilot study, 61 specimen sets were distributed with 45 participants returning results within the specified period, representing a good return rate of 73.8% for a first pilot. The overall performance for this distribution was very good with 95.4% of participants returning the intended results using their first method and 94.3% returning intended results with their second method.

In the second pilot, 129 specimen sets were distributed with 88 participants returning results within the specified period, representing an average return rate of 68.2%. Overall performance for this second pilot studies was very good with 93.1% of participants returning the intended results using their first method and 81.5% returning intended results with their second method.

Subsequently, a first live distribution was dispatched on the 21st June 2021, consisting of 4 specimens prepared using inactivated SARS-CoV-2 (England/02/2020 Lineage A). The return rate was of 84.7% with an excellent overall performance of 97.5% for the first method and 93% for the second method reported by the participants.

The interest in this scheme is growing with more enquiries and registrations. The scheme has until now been run only in the UK (to collate sufficient evidence on the stability of the specimens), and now will be offered internationally.

Variants such as the Alpha, Beta, Delta etc. will also be included in future distributions.

The table below illustrates the distribution schedule and closing dates for the UK NEQAS SARS-CoV-2 Antigen EQA, for March 2021- April 2022 distribution year.

Distribution number Dispatch date Closing date
5147 21st June 2021 5th July 2021
5148 23rd August 2021 6th September 2021
5153 4th October 2021 18th October 2021
5154 29th November 2021 6th December 2021
5155 17th January 2022 31st  January 2022
5156 14th March 2022 28th March 2022

 


If you are interested or have any further queries on this EQA scheme please email us at: organiser@ukneqasmicro.org.uk  stating “SARS-CoV-2 antigen EQA”

Carbapenemase producing organisms (CPO)

Carbapenems are broad spectrum antibiotics often reserved for the critically ill. Their increased and, often, inappropriate use, has led to the development of resistance, through acquisition of carbapenemase enzymes. There are five carbapenemases that predominate worldwide (the “big five”): VIM, NDM, KPC, OXA-48 and IMP. However, the true prevalence of carbapenemases is unknown. Therefore, prompt detection, targeted screening, effective control measures and surveillance are required to reduce further transmission of these multi-drug resistant organisms. Due to increased carbapenemase producing organism (CPO) prevalence, there is demand for diagnostic laboratories to perform local detection of the major carbapenemase families. To assess the performance in the standard of service provided by laboratories, there is the need for an external quality assessment (EQA) scheme in the detection of the ‘big five’ – VIM, NDM, KPC, OXA-48, and IMP.

The first pilot for the carbapenemase producing organisms (CPO) scheme was dispatched early June 2021. This pilot included two specimens, comprising of one freeze-dried vial and one liquid transport swab. Results were requested to be reported via a Select Survey link sent to the nominated person who registered interest in the pilot.

Prior to dispatch, UK NEQAS for Microbiology performed 8 weeks of stability and homogeneity testing on freeze-dried material and three different swab types. This ensured that the yield of the organism was stable and the carbapenemase could be detected up to 8 weeks post preparation.

Three pilots in total will be distributed to registered participants. Results will then be collated and the final details on the scheme, including frequency, number of specimens and specimen format, will be made available.

SCHEME INFORMATION

Antimicrobial susceptibility scheme FAQ

Qu- How are the isolates and antibiograms selected?

The Antimicrobial Susceptibility Testing Specialist Advisory Group (ASTSAG), is a meeting which is held once a year and made up of the Scheme Organiser and Scheme Manager for Bacteriology & Mycology, Biomedical Scientists, Clinical Scientists and Clinical Microbiologists, all specialising in antimicrobial resistance. During this meeting, we discuss:

  • Challenges and areas of low concordance
  • Trends of over reporting or under reporting
  • Changes and updates with EUCAST guidelines & methods
  • Ways in which the scheme could be improved
  • Panels of antimicrobial agents to be used against each isolate/site
  • Addition of new antimicrobials to the panels where necessary
  • Micro organisms to be included in the scheme the following year
  • Scoring

Isolates to be included within the following years distribution are discussed and finalised during the ASTSAG meeting, with input from all members.

We have an opening for a new member to join this advisory group. Please view our website for more details and how to apply: https://ukneqasmicro.org.uk/images/pdf/ASTSAG.pdf

Qu- What testing is performed prior to distribution?

 Testing of isolates are initially performed by independent reference laboratories by broth microdilution. Reference laboratories used by UK NEQAS for Microbiology include the Specialist Antimicrobial Testing Unit (SACU), Wales and the EUCAST Development Laboratory (EDL), . Any discrepant results and the isolate is referred to a third reference laboratory for confirmation. Once isolates have been freeze-dried, they are referred again to the reference laboratories to confirm the antibiogram has not been affected by the lyophilisation. Several quality control checks are performed by UK NEQAS throughout the preparation of the specimens to ensure the isolate is exhibiting colonial characteristics  typical of the organism on solid media, is pure, stable and viable prior to distribution.

Qu- Which organisms are currently included within the scheme?

Any non-hazard group 3 pathogen can be included within this scheme. We try to provide a variety of organisms, including more routinely isolated pathogens (S. aureus, E. coli), in addition to more unusual bacteria and antibiograms which can be used as an educational tool.

Qu- What version of EUCAST guidelines do you follow at UK NEQAS?

At UK NEQAS for Microbiology we follow the latest published guidelines, currently version 11. Where interpretations differ between version 11 and version 10, these agents have previously not been scored. Going forwards from 2022, distributions will be scored in line with the most recently updated version of guidelines issued.

Qu- Which method of susceptibility testing do you follow?

The Specialist Antimicrobial Testing Unit and EUCAST Development Laboratory both use broth micro dilution as the gold standard. Agar dilution is used as a gold standard when applicable (i.e. fosfomycin). Gradient strips and EUCAST disk diffusion methods are also used.

Qu- What if the isolate falls into the ATU or ECOFF?

Previously these agents have not been scored. However, going forward scoring will be based on participant concordance and the bacteriology scoring policy located on our website: https://www.ukneqasmicro.org.uk/images/pdf/DOC.0392.pdf.

Qu- When is an agent not scored?

There are various reasons why an agent may not be scored, these include:

  • Differences in interpretations by EUCAST and CLSI
  • Less than 80% concordance with intended results*
  • No guidelines to interpret the agent

Scoring may be applied where low concordance is due to incorrect methods being used for a reported result

Qu- How is concordance calculated?

Concordance is calculated as the percentage of laboratories who report in line with the intended result. Please view the website, Table 7 for a breakdown: https://www.ukneqasmicro.org.uk/images/pdf/DOC.0392.pdf

Qu- Does this scheme cater for both EUCAST and CLSI users?

In short- yes.

Both sets of breakpoints are located throughout the report and the scoring is adjusted accordingly. For example, if the EUCAST interpretation is susceptible (‘S’) and the CLSI interpretation is intermediate increased exposure (‘I’)- both are awarded the maximum score of 2 and the concordance is linked.

For an example of a report, please visit: http://www.ukneqasmicro.org.uk/images/pdf/SpecimenReports/as.pdf

POSTERS, PRESENTATIONS AND PAPERS

ECCMID:
A look back of 50 years in UK National External Quality Assessment Service for Microbiology.

ECCMID: A look back of 50 years in UK National External Quality Assessment Service for Microbiology.

Virtual SfAM:
Introduction of a Carbapenemase Producing Organisms (CPO) External Quality Assessment Scheme by UK NEQAS for Microbiology. (Oral presentation)

ECCMID 2021: A five-years review of the UK NEQAS Molecular detection of respiratory viruses
external quality assessment scheme (Oral Presentation)

Virtual WHO seminar on laboratory diagnostics of Diphtheria in Greece: Importance of European Quality Assurance and EQA.

Virtual ELDSNet Legionella: ECDC External Quality Assessment (EQA) scheme supporting the surveillance of legionnaires' disease at European level

Series of 6 webinars to celebrate UK NEQAS for Micro’s 50th: https://ukneqasmicro.org.uk/images/pdf/webinars.pdf

UK NEQAS (Shila Seaton) are contributors to the following paper;

Title: The Global Landscape of Pediatric Bacterial Meningitis Reported to the WHO-coordinated Invasive Bacterial Vaccine-Preventable Disease Surveillance Network, 2014-2019

The paper has now been accepted for publication in the Journal of Infectious Diseases

The World Health Organization (WHO) coordinates the Global Invasive Bacterial Vaccine-Preventable Diseases (IB-VPD) Surveillance Network to support vaccine introduction decisions and use. The network was established to strengthen surveillance and laboratory confirmation of meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis.

UK NEQAS in collaboration with WHO, provided an EQA annually (2014-2019) to clinical diagnostic and region reference medical microbiology laboratories from countries in the African region.

The paper includes the performance of the laboratories whom participated in the EQA on the isolation and identification of the three major bacterial causative agents for meningitis: Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae.

Simulated cerebral spinal fluid (CSF) specimens were dispatched to participants using conventional and or molecular techniques. Results were returned to UK NEQAS within a set period, dependent on the laboratories capacity to provide this service.

Customer Satisfaction Survey

Dear Participant

UK NEQAS for Microbiology is committed to ensuring that our service remains relevant for your laboratory.

If you haven’t already done so, we would appreciate you taking a couple of minutes to complete this short questionnaire by the end of day on Tuesday 31st August 2021 to help us identify areas where we can improve our service to you.


https://ukneqasmicro.org.uk/website-survey

Your feedback is vital in assisting us in making future changes.

Thank you for your continued support.

UK NEQAS for Microbiology

SAVE THE DATE

Save the Date_UK NEQAS Pan-Disciplinary Webinars

We would like to welcome the following new starters

Viraj Acharya – Operations Administrator

Kamyar Ameri – Information Officer

Yvette Agbeko – Quality Administrator

Isis Asamoah – Healthcare Scientist Practitioner

Ariana Derguti – Healthcare Scientist Support Worker

Rhian Fraser – Healthcare Scientist Specialist

Jake de los Reyes – Healthcare Scientist Support Worker

Rhiannon Weale – Healthcare Scientist Specialist

Paul Ejiofor – Healthcare Scientist Support Worker

Rachel Prince – Healthcare Scientist Support Worker

We wished farewell to the following staff:

Paul Chadwick – Scheme Organiser (Interpretative Comments)

Irena Venn – Healthcare Scientist Practitioner (R&D)

Puja Shah – Healthcare Scientist Specialist

Chloe Campbell – Healthcare Scientist Support Worker

Danielle Mack – Production Supervisor

Li Sa Choo – Healthcare Scientist Practitioner (R&D)

Muna Jama – Healthcare Scientist Practitioner

 

UK NEQAS for Microbiology

would also like to say a huge thank you and wish the very best of luck to Paul Chadwick who has been a great support to UK NEQAS for Microbiology for many years. Enjoy your retirement!

Thank you to all our participants, distributors, steering committee and advisory members, expert advisors, freight-forwarders, panel members and Public Health England for their continued support.

Thank you to all our participants, distributors, steering committee and advisory members, expert advisors, freight-forwarders, panel members and Public Health England for their continued support.

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