Laboratory evaluation of susceptibility tests for National Antimicrobial Resistance Surveillance System (NAMRSS) in Turkey

Abstract

Objective: Antimicrobial resistance is a growing problem worldwide, and to combat with this problem some measures should be taken. One of them is analysis of current situation and National Antimicrobial Resistance Surveillance System (NAMRSS) was established for this purpose. The quality of the data depends on the participating laboratories performance, so there was need for an assessment of the laboratories in the system. This study was aimed to analyse the status of the participating laboratories for antimicrobial susceptibility testing requirements. Methods: There were 77 participating laboratories selected for NAMRSS throughout the country. Twenty-five of them were included in for capacity analysis study. A Laboratory Assessment Tool (LAT) was used for the evaluation of laboratories with 'checklist' features, and face-to-face interviews were used. LAT was a programme containing 677 questions in 10 modules that were developed by World Health Organization (WHO). A set of questions were added to use for antimicrobial susceptibility tests (AST). Teams were formed from a total of 33 volunteer experts who received training prior to laboratory visits in a workshop, and there were at least two people in each team. They have visited the laboratories for implementing the LAT. Data were transferred to a database and analysed for both general conditions, and AST capacity. Results: Laboratories were distributed institutionally as university hospital (n=17), training and research hospital (n = 4), state hospital (n = 2) and military hospital (n = 2). NAMRSS laboratories performed identification and AST by automated systems as well as disc diffusion and minimum inhibitory concentration (MIC) tests except for one laboratory. Also, the laboratories were generally in 'good standing' (approx. > 85%) for three of the modules, where the other modules suggest that there are issues that 'need some improvements' at different degrees. When focused on AST, outside of internal quality control applications, it was observed that availability for AST culture media and reagents, identification and AST capacity are between 84-95%. It was found that total quality was 67%. Conclusion: NAMRSS laboratories seem to be able to provide reliable results in AST, which is essential for both surveillance system and evidence based decisions in effective treatment of patients. On the other hand, improvement in some other issues is necessary.