African laboratories show steady gains in antimicrobial susceptibility testing quality

Reference and sentinel laboratories across Africa that took part in the EQuAFRICA external quality assessment programme between 2021 and 2025 scored 83% on average for pathogen identification and 73% for antimicrobial susceptibility testing, according to a new analysis published in PLOS Global Public Health. The programme was designed to build regional capacity for a One Health bacteriology proficiency testing scheme serving laboratories that support antimicrobial resistance surveillance and submit data to the World Health Organization’s Global Antimicrobial Resistance and Use Surveillance System, known as GLASS.

The assessment covered all GLASS pathogens and other bacterial pathogens of public health importance. One survey was distributed in 2021 and 2023, and two surveys were distributed in each of 2022, 2024 and 2025, with five isolates per survey. Participants were selected among reference and designated sentinel antimicrobial resistance laboratories from the 14 Fleming Fund recipient countries in Africa. Performance was scored using the Clinical Microbiology Proficiency Testing marking scheme, and the number of invited, enrolled and responding laboratories differed by survey. On average, 85% of enrolled laboratories submitted results across the cycles.

Laboratories from the human health sector made up the majority of participants in every cycle, accounting for 75% of the panel. The analysis found no participants that scored zero for antimicrobial susceptibility testing, and the authors report that poorly performing susceptibility testing at the beginning of the programme improved over time. However, critical errors with direct clinical implications for directed treatment were still observed, involving vancomycin and cefoxitin results for staphylococci.

They conclude that building sustainable capacity for bacteriology testing, including susceptibility testing, is critically important at all laboratory levels across Africa, from routine clinical and surveillance sites to national reference laboratories. The authors highlight that EQA programmes are vital for detecting gaps in laboratory processes and maintaining the quality and accuracy of antimicrobial susceptibility testing, which is important for effective AMR surveillance and control.

Subject of Research: Laboratory performance in antimicrobial susceptibility testing for GLASS pathogens in the EQuAFRICA external quality assessment programme, 2021–2025

Article Title: Laboratory performance of antimicrobial susceptibility testing for GLASS pathogens among participants in the EQuAfrica programme, 2021‒2025

Article References: Perovic, O., van der Puije, B., Carter, J. Y., Humwa, F., Badat, R., Mwiti, D., Smith, M., Poulo Ly, F., Fall, C., Dièye, Y., Dabula, P., Hendriksen, R. S., Tebeje, Y. K., & Ondoa, P. (2026). Laboratory performance of antimicrobial susceptibility testing for GLASS pathogens among participants in the EQuAfrica programme, 2021‒2025. PLOS Global Public Health, 6(10), e0007478. https://doi.org/10.1371/journal.pgph.0007478

Image Credits: AI Generated

DOI: 10.1371/journal.pgph.0007478

Keywords: antimicrobial resistance, EQuAFRICA, GLASS, proficiency testing, external quality assessment, antimicrobial susceptibility testing, Africa, laboratory capacity, Fleming Fund, surveillance, bacteriology, public health