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

Abstract

Objective: Antimicrobial resistance is a growingproblem worldwide, and to combat with this problemsome measures should be taken. One of them isanalysis of current situation and National AntimicrobialResistance Surveillance System (NAMRSS) wasestablished for this purpose. The quality of the datadepends on the participating laboratories performance,so there was need for an assessment of the laboratoriesin the system. This study was aimed to analyse thestatus of the participating laboratories for antimicrobialsusceptibility testing requirements.Methods: There were 77 participating laboratoriesselected for NAMRSS throughout the country. Twentyfive of them were included in for capacity analysisstudy. A Laboratory Assessment Tool (LAT) was used forthe evaluation of laboratories with ‘checklist’ features,and face-to-face interviews were used. LAT was aprogramme containing 677 questions in 10 modules thatwere developed by World Health Organization (WHO).A set of questions were added to use for antimicrobialsusceptibility tests (AST). Teams were formed froma total of 33 volunteer experts who received trainingprior to laboratory visits in a workshop, and there wereat least two people in each team. They have visitedthe laboratories for implementing the LAT. Data weretransferred to a database and analysed for both generalconditions, and AST capacity.Results: Laboratories were distributedinstitutionally as university hospital (n=17), trainingand research hospital (n = 4), state hospital (n = 2) andmilitary hospital (n = 2). NAMRSS laboratories performedidentification and AST by automated systems as well asdisc diffusion and minimum inhibitory concentration(MIC) tests except for one laboratory. Also, thelaboratories were generally in ‘good standing’ (approx.> 85%) for three of the modules, where the othermodules suggest that there are issues that ‘need someimprovements’ at different degrees. When focused onAST, outside of internal quality control applications, itwas observed that availability for AST culture media andreagents, identification and AST capacity are between84-95%. It was found that total quality was 67%.Conclusion: NAMRSS laboratories seem to be ableto provide reliable results in AST, which is essential forboth surveillance system and evidence based decisionsin effective treatment of patients. On the other hand,improvement in some other issues is necessary.