Ten years of external quality assessment (EQA) of Neisseria gonorrhoeae antimicrobial susceptibility testing in Europe elucidate high reliability of data

Michelle Cole*, Nerteley Quaye, Susanne Jacobsson, Michaela Day, Elizabeth Fagan, Catherine Ison, Rachel Pitt, Shila Seaton, Neil Woodford, Angelika Stary, Sonja Pleininger, Tania Crucitti, Blaženka Hunjak, Panayiota Maikanti, Steen Hoffmann, Jelena Viktorova, Susanne Buder, Peter Kohl, Eva Tzelepi, Eirini SiatravaniEszter Balla, Gurún Svanborg Hauksdóttir, Lisa Rose, Paola Stefanelli, Anna Carannante, Gatis Pakarna, Francesca Mifsud, Rosann Zammit Cassar, Ineke Linde, Thea Bergheim, Martin Steinbakk, Beata Mlynarczyk-Bonikowska, Maria José Borrego, Jill Shepherd, Peter Pavlik, Samo Jeverica, Julio Vazquez, Raquel Abad, Sabrina Weiss, Gianfranco Spiteri, Magnus Unemo

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


Background: Confidence in any diagnostic and antimicrobial susceptibility testing data is provided by appropriate and regular quality assurance (QA) procedures. In Europe, the European Gonococcal Antimicrobial Susceptibility Programme (Euro-GASP) has been monitoring the antimicrobial susceptibility in Neisseria gonorrhoeae since 2004. Euro-GASP includes an external quality assessment (EQA) scheme as an essential component for a quality-assured laboratory-based surveillance programme. Participation in the EQA scheme enables any problems with the performed antimicrobial susceptibility testing to be identified and addressed, feeds into the curricula of laboratory training organised by the Euro-GASP network, and assesses the capacity of individual laboratories to detect emerging new, rare and increasing antimicrobial resistance phenotypes. Participant performance in the Euro-GASP EQA scheme over a 10 year period (2007 to 2016, no EQA in 2013) was evaluated. Methods: Antimicrobial susceptibility category and MIC results from the first 5 years (2007-2011) of the Euro-GASP EQA were compared with the latter 5 years (2012-2016). These time periods were selected to assess the impact of the 2012 European Union case definitions for the reporting of antimicrobial susceptibility. Results: Antimicrobial susceptibility category agreement in each year was ≥91%. Discrepancies in susceptibility categories were generally because the MICs for EQA panel isolates were on or very close to the susceptibility or resistance breakpoints. A high proportion of isolates tested over the 10 years were within one (≥90%) or two (≥97%) MIC log 2 dilutions of the modal MIC, respectively. The most common method used was Etest on GC agar base. There was a shift to using breakpoints published by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) in the latter 5 years, however overall impact on the validity of results was limited, as the percentage categorical agreement and MIC concordance changed very little between the two five-year periods. Conclusions: The high level of comparability of results in this EQA scheme indicates that high quality data are produced by the Euro-GASP participants and gives confidence in susceptibility and resistance data generated by laboratories performing decentralised testing.

Original languageEnglish
Article number281
JournalBMC Infectious Diseases
Issue number1
Publication statusPublished - 25 Mar 2019

Bibliographical note

Funding Information:
The study was funded by the European Centre for Disease Prevention and Control (Framework Contract No. ECDC/2013/015). The funding body contributed to the design of the study, the interpretation of the data and to the writing of the manuscript.


  • Euro-GASP
  • European Union (EU)
  • European economic area (EEA)
  • Gonorrhoea


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