Combined international external quality assessment results of medical laboratory performance and reporting of samples with known antimicrobial resistance
-
Michael A. Noble
and
Robert Rennie
Abstract
Background
Reporting on the presence of antimicrobial resistance is of considerable concern both for individual patient care and for understanding the underlying health status within the community at large. Antimicrobial resistance is solely dependent upon clinical laboratory detection and thus can be impacted upon by the quality and competence of medical laboratories. Proficiency testing or external quality assessment (PT/EQA) is the international standard for the direct measurement of medical laboratory performance on critical testing.
Methods
An international, intercontinental collaborative retrospective study of medical laboratory performance in antibiotic resistance was performed by the Microbiology Working Group (MWG) of the European Organisation for External Quality Assurance for Laboratory Medicine (EQALM) with particular examination of laboratory performance on the testing and reporting of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and carbapenem-resistant Enterobacteriaceae (CRE).
Results
The results of 1880 medical laboratories were compiled. Strictly accurate reporting of isolates as resistant occurred with MRSA 96.9%, with VRE 91.3% and with CRE 93.1% of the time. On the other hand, very major errors (reporting of false susceptibility) were observed with 2.2% of MRSA and 2.4% of VRE and 0.8% of CRE. Major errors (false resistance) were reported for vancomycin susceptibility testing for MRSA at a rate of 0.6%.
Conclusions
Depending on how clinical physicians read and understand microbiology susceptibility reports, proficient acceptable results were reported either between 91% and 94% of the time, or between 97% and 100%. While very major errors are infrequently reported, they were found in all regions and could potentially cause poor treatment decisions by clinicians. A collective analysis of multi-program PT/EQA information can provide valuable insights into the testing and reporting practices of medical laboratories.
Acknowledgments
The authors acknowledge the leadership and support of the EQALM Scientific Committee including Piet Meijer (Netherlands, chair), Wim Coucke (Belgium), Joan-Lluis Vives Corrons (Spain), Istvan Juhos (Hungary), Ann Helen Kristoffersen (Norway) and Michael Noble (Canada), and advisor Anne Stavelin (Norway, chair EQALM).
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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©2018 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Editorial
- The need for cognition and the curse of cognition
- Review
- Beyond Dr. Google: the evidence on consumer-facing digital tools for diagnosis
- Opinion Papers
- Improving diagnosis by improving education: a policy brief on education in healthcare professions
- Diagnostic stewardship and the 2017 update of the IDSA-SHEA Clinical Practice Guidelines for Clostridium difficile Infection
- The approach to a diagnostic dilemma
- Original Articles
- Cognitive error in an academic emergency department
- How common are cognitive errors in cases presented at emergency medicine resident morbidity and mortality conferences?
- Mind the overlap: how system problems contribute to cognitive failure and diagnostic errors
- Pediatric hypertension: diagnostic patterns derived from electronic health records
- Combined international external quality assessment results of medical laboratory performance and reporting of samples with known antimicrobial resistance
- Letter to the Editor
- Interruptions, work environment and work load perceptions in laboratory medicine: patient safety is a “moving target”
- Congress Abstracts
- 2nd European Conference on Diagnostic Error in Medicine August 30-31, 2018, Bern, Switzerland
Articles in the same Issue
- Frontmatter
- Editorial
- The need for cognition and the curse of cognition
- Review
- Beyond Dr. Google: the evidence on consumer-facing digital tools for diagnosis
- Opinion Papers
- Improving diagnosis by improving education: a policy brief on education in healthcare professions
- Diagnostic stewardship and the 2017 update of the IDSA-SHEA Clinical Practice Guidelines for Clostridium difficile Infection
- The approach to a diagnostic dilemma
- Original Articles
- Cognitive error in an academic emergency department
- How common are cognitive errors in cases presented at emergency medicine resident morbidity and mortality conferences?
- Mind the overlap: how system problems contribute to cognitive failure and diagnostic errors
- Pediatric hypertension: diagnostic patterns derived from electronic health records
- Combined international external quality assessment results of medical laboratory performance and reporting of samples with known antimicrobial resistance
- Letter to the Editor
- Interruptions, work environment and work load perceptions in laboratory medicine: patient safety is a “moving target”
- Congress Abstracts
- 2nd European Conference on Diagnostic Error in Medicine August 30-31, 2018, Bern, Switzerland
