Saeed Dania Khalid, Hasan Rumina, Naim Mahwish, Zafar Afia, Khan Erum, Jabeen Kausar, Irfan Seema, Ahmed Imran, Zeeshan Mohammad, Wajidali Zabin, Farooqi Joveria, Shakoor Sadia, Chagla Abdul, Rao Jason
Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan.
Baqai Institute of Health Sciences, Baqai Medical University, Karachi, Pakistan.
Antimicrob Resist Infect Control. 2017 Sep 29;6:101. doi: 10.1186/s13756-017-0260-6. eCollection 2017.
Limited capacity of laboratories for antimicrobial susceptibility testing (AST) presents a critical diagnostic bottleneck in resource limited countries. This paper aims to identify such gaps and to explore whether laboratory networks could contribute towards improving AST in low resource settings.
A self-assessment tool to assess antimicrobial susceptibility testing capacity was administered as a pre-workshop activity to participants from 30 microbiology laboratories in 3 cities in Pakistan. Data from public and private laboratories was analyzed and capacity of each scored in percentage terms. Laboratories from Karachi were invited to join a support network. A cohort of five laboratories that consented were provided additional training and updates sessions over a period of 15 months. Impact of training activities in these laboratories was evaluated using a point scoring (0-11) tool.
Results of self-assessment component identified a number of areas that required strengthening (scores of ≤60%). These included; readiness for AMR surveillance; 38 and 46%, quality assurance; 49 and 55%, and detection of specific organisms; 56 and 60% for public and private laboratories respectively. No significant difference was detected in AST capacity between public and private laboratories [ANOVA; > 0.05]. Scoring tool used to assess impact of training within the longitudinal cohort showed an increase from a baseline of 1-5.5 (August 2015) to improved post training scores of 7-11 (October 2016) for the 5 laboratories included. Moreover, statistical analysis using paired t-Test Analysis, assuming unequal variance, indicated that the increase in scored noted represents a statistically significant improvement in the components evaluated [ < 0.05].
Strengthening of laboratory capacity for AMR surveillance is important. Our data shows that close mentoring and support can help enhance capacity for antimicrobial sensitivity testing in resource limited settings. Our study further presents a model wherein laboratory networks can be successfully established and used towards improving diagnostic capacity in such settings.
在资源有限的国家，实验室进行抗菌药物敏感性试验（AST）的能力有限是一个关键的诊断瓶颈。本文旨在找出这些差距，并探讨实验室网络是否有助于改善资源匮乏地区的AST。
作为研讨会前的一项活动，向巴基斯坦3个城市的30个微生物实验室的参与者发放了一份评估抗菌药物敏感性试验能力的自我评估工具。对公立和私立实验室的数据进行了分析，并以百分比形式对每个实验室的能力进行了评分。邀请卡拉奇的实验室加入一个支持网络。同意参与的5个实验室组成的队列在15个月的时间里接受了额外的培训和更新课程。使用评分（0-11）工具评估这些实验室培训活动的影响。
自我评估部分的结果确定了一些需要加强的领域（得分≤60%）。这些领域包括：抗菌药物耐药性监测的准备情况；公立和私立实验室分别为38%和46%，质量保证；分别为49%和55%，以及特定生物体的检测；分别为56%和60%。公立和私立实验室之间的AST能力未检测到显著差异[方差分析；P>0.05]。用于评估纵向队列中培训影响的评分工具显示，所纳入的5个实验室从2015年8月的基线1-5.5分提高到培训后的7-11分。此外，使用配对t检验分析（假设方差不等）的统计分析表明，得分的增加代表了所评估组件的统计学显著改善[P<0.05]。
加强实验室进行抗菌药物耐药性监测的能力很重要。我们的数据表明，密切的指导和支持有助于提高资源有限环境中抗菌药物敏感性试验的能力。我们的研究进一步提出了一个模型，其中可以成功建立实验室网络并用于提高此类环境中的诊断能力。
