NRMM – Results of the NRMM EQA distributions raise important issues!

The first “Nordic EQA shipment” was arranged by Per Sandven and distributed in the Nordic countries in February 2005. It consisted of five simulated patient samples to be handled exactly the same way as ordinary, routine specimens are handled. Enclosed in the shipment were questionnaires focusing on the methods used.

Medical microbiology laboratories in the five Nordic countries were invited to participate at no cost and 55 laboratories accepted this offer (Denmark: 4, Finland: 6, Iceland: 1, Norway: 23 and Sweden 21 laboratories). In our view some very interesting information and conclusions followed the results of the distribution especially with respect to time to final results and variations in susceptibility test results achieved.

 

The second “Nordic EQA shipment” was arranged by Victor Fernandez from the Swedish Institute for Infectious Disease Control (SMI) and distributed in the Nordic countries in March 2006. Again the shipment was composed by five simulated clinical samples, however this time some of the samples contained multiple fungal microorganisms in order to resemble the clinical situation somewhat more. Fifty-nine Nordic laboratories participated: DK: 12, NO: 19, FI: 8 and SE: 20 laboratories. The laboratories were encouraged to handle the samples like routine specimens, in order to obtain a true picture of the mycological procedures used in the Nordic countries. It is our impression that this instruction was at least in part followed. A report has been made and sent to all participating laboratories. Important findings are:

1. 66% of the laboratories failed to detect that sample no 1 (blood culture) contained not only C. albicans but also C. glabrata. Recommendation: Use chromogenic agars, secure proper spreading allowing single colonies and observe carefully for mixed cultures for at least 3 days.

2. 34% of the laboratories reporting susceptibility results failed to recognise that a Cryptococcus neoformans isolate was not fluconazole susceptible. Recommendation: If the lab decides to perform susceptibility testing a critical number of isolates should be tested by the technicians and quality control strains should be included at a regular basis.

3. 24% of the laboratories failed to detect Aspergillus fumigatus which was present together with C. albicans and Enterobacter cloacae in a BAL sample from a neutropenic patient in an ICU. Recommendation: Awareness of mould infection and especially A. fumigatus in such a high risk population should be increased.

In our point of view, this distribution of simulated clinical samples has been educational and illustrate that the traditional quality assessment programs may give a false sense of well performance. It also illustrates that mycological diagnosis is difficult and that there is a need of further improvement and attention.

If interested you may download the reports here: 

Report 2005

Report 2006 (pending publication; can be acquired from Maiken Cavling Arendrup)

 

 

M Cavling Arendrup, E Chryssanthou, P Gaustad, M Koskela, P Sandven, V Fernandez 09.06.2006