J Lab Med Qual Assur.  2016 Dec;38(4):169-193. 10.15263/jlmqa.2016.38.4.169.

Annual Report on the External Quality Assessment Scheme for Clinical Microbiology in Korea (2015)

Affiliations
  • 1Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. mnkim@amc.seoul.kr
  • 2Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
  • 3Department of Laboratory Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
  • 4Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 5Department of Laboratory Medicine, Kyungsang National University Hospital, Kyungsang National University School of Medicine, Jinju, Korea.
  • 6Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 7Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
  • 8Department of Laboratory Medicine, Korean Institute of Tuberculosis, Cheongju, Korea.
  • 9Department of Laboratory Medicine, Greencross Reference Laboratory, Yongin, Korea.
  • 10Department of Laboratory Medicine, Kosin University Gospel Hospital, Busan, Korea.
  • 11Department of Laboratory Medicine, Korea University Ansan Hospital, Ansan, Korea.

Abstract

Annual proficiency surveys were conducted in March, June, and September in 2015 by the Clinical Microbiology Subcommittee of the Korean Association of External Quality Assessment Service. The program covers the sections of bacteriology, advanced bacteriology and mycology, mycobacteriology, and parasitology. Each trial was composed of three sets of different combinations of five bacteria and yeasts. These sets were distributed among laboratories for Gram staining, culture, identification, and antimicrobial susceptibility tests. Five slides with fixed sputum smears were provided as part of each trial for acid-fast bacilli detection. The survey material distribution was section-based. Two survey materials were provided in each trial, while five specimens for mycobacterial culture and identification, five specimens for anti-tuberculosis susceptibility testing and two Mycobacterium tuberculosis strains for rapid detection of rifampin and isoniazid resistance were distributed in the March and June trials. Five virtual microscopy files for stool parasite examination were availed by registered participants in the June trial. Out of the 334 enrolled laboratories, 328 (98.2%), 328 (98.2%), and 329 (98.5%) submitted responses in trials I, II, and III, respectively. Identification of bacteria, namely, Escherichia coli, Klebsiella pneumoniae, Enterococcus faecalis, Pseudomonas aeruginosa, Streptococcus pneumoniae, and Vibrio fluvialis by more than 95% of participants was acceptable. Surveillance cultures for vancomycin-resistant enterococci and carbapenem-resistant Enterobacteriaceae were determined accurately by 75.8%-85.3% and 93.1% of the respondents, respectively. Species-level identification of Candida krusei, Candida lusitanae, and Candida guilliermondii was still low at 79.8%, 55.7%, and 42.7%, respectively. Disk diffusion method revealed an unacceptably high false-positive rate of resistance to glycopeptides in E. faecalis and to trimethoprim-sulfamethoxazole in S. pneumoniae. Advanced bacteriology trials revealed unsatisfactory results for species-level identification of moulds. Mycobacterial culture, identification and susceptibility testing, and molecular detection of rifampin and isoniazid resistance were performed exceedingly well by participants. Hymenolepsis diminuta could not be identified by participants, with a correct answer rate of only 46.5% and "˜no parasite seen' answer rate of only 31.8% for negative specimens. Species-level identification of Candida and moulds was challenging for clinical microbiology laboratories. Disk diffusion method was found to be problematic in testing the susceptibility of microorganisms to glycopeptides and trimethoprim-sulfamethoxazole. Improvement is required in result interpretation of negative specimens in parasitology.

Keyword

Quality control; Parasitology; Bacteriology; Microbiology; Mycobacterium; Antimicrobial susceptibility

MeSH Terms

Bacteria
Bacteriology
Candida
Diffusion
Enterobacteriaceae
Enterococcus faecalis
Escherichia coli
Glycopeptides
Isoniazid
Klebsiella pneumoniae
Korea*
Methods
Microscopy
Mycobacterium
Mycobacterium tuberculosis
Mycology
Parasites
Parasitology
Pneumonia
Pseudomonas aeruginosa
Quality Control
Rifampin
Sputum
Streptococcus pneumoniae
Surveys and Questionnaires
Trimethoprim, Sulfamethoxazole Drug Combination
Vancomycin-Resistant Enterococci
Vibrio
Yeasts
Glycopeptides
Isoniazid
Rifampin
Trimethoprim, Sulfamethoxazole Drug Combination
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