Search for


search for

Annual Report on External Quality Assessment Scheme for Clinical Microbiology in Korea (2014)
J Lab Med Qual Assur 2015;37:153-178
Published online December 31, 2015
© 2015 Korean Association of Quality Assurance for Clinical Laboratory.

Young Jin Ko1, Mi-Na Kim1, Eui Chong Kim2, Jong Hee Shin3, Nam Yong Lee4, Sunjoo Kim5, Seok Hoon Jeong6, Jae- Seok Kim7, Chang Ki Kim8, Hye Gyung Bae9, Nam Surp Yoon1, Se Ik Joo2, Yu Yeon Hwang4, Keonhan Kim6, In Ho Jang10, and Jin Heo11, as Clinical Microbiology Subcommittee, Korean Association of External Quality Assessment Service

1Department of Laboratory Medicine, University of Ulsan and Asan Medical Center, Seoul;
2Department of Laboratory Medicine, Seoul National University Hospital, Seoul;
3Department of Laboratory Medicine, Chonnam National University Hospital, Gwangju;
4Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul;
5Department of Laboratory Medicine, Kyungsang National University Hospital, Jinju;
6Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul;
7Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul;
8Department of Laboratory Medicine, Korean Institute of Tuberculosis, Cheongju;
9Department of Laboratory Medicine, Greencross Reference Laboratory, Yongin;
10Department of Laboratory Medicine, Wonju Severance Christian Hospital, Wonju;
11Department of Laboratory Medicine, Korea University Ansan Hospital, Ansan, Korea
Correspondence to: Mi-Na Kim
Department of Laboratory Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-4511 Fax: +82-2-478-0884 E-mail:
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Annual proficiency surveys were performed in March, June and September 2014 by clinical microbiology division of The Korean Association of Quality Assurance for Clinical Laboratory. Parasitology part has been newly incorporated in this survey. For each trial, three sets which were composed of different combinations of five bacteria and yeast were distributed for gram stain, culture, identification, and antimicrobial susceptibility tests of general bacteriology and five fixed sputum smear on slides were distributed for acid fast bacilli stain. Two advanced bacteriology survey materials for culture and identification of anaerobic bacteria and mold were distributed to the voluntary participants in every trial and five mycobacterial culture and identification specimens, five anti-tuberculosis susceptibility testing specimens, and two Mycobacterium tuberculosis strains for rapid detection of rifampin and isoniazid resistance were distributed to the voluntary participants in March and June trials. Five virtual microscopic slides for stool parasite examination were open for the registered participants in June trial. A total of 340 laboratories were enrolled and 330 (97.0%), 331 (97.4%), and 331 (97.4%) returned the results on trial I, II, and III, respectively. For bacterial identification, the percent acceptable identification of Burkholderia cepacia , Klebsiella pneumoniae , Streptococcus pyogenes , Staphylococcus aureus , Pseudomonas aeruginosa , Streptococcus pneumoniae , Streptococcus agalactiae , Plesiomonas shigelloides , and Enterococcus faecalis were greater than 95%. Group C and group D Salmonella species challenged as the different sets of M1422 resulted in the acceptable rate lower than 95% because nine participants reported the identification of different sets. Surveillance cultures for methicillin-resistant S . aureus and vancomycin-resistant enterococci were correctly determined by 89.6% and 69.0% of the respondents, respectively. Correct identification to species level of Candida albicans, Candida auris , Candida glabrata , and Candida parapsilosis were 86.1%, 1.6%, 48.1%, and 83.8%. Vancomycin disk diffusion test in S . aureus , missing oxacillin screen or penicillin susceptibility test in S . pneumoniae and lack of reliable methods of quinolone resistance detection in Salmonella species caused unacceptable results in antimicrobial susceptibility testing. Advanced bacteriology trials revealed low performance in species identification of mold. Mycobacterial culture, identification and susceptibility test performance was kept in excellence. The performance of identification of stool parasites was acceptable >90% for detection of helminth eggs and amebic cysts but 28.6% false positive responses resulted from negative specimens. In conclusion, species-level identification of fungi of both candida species and mold were challenging to clinical microbiology laboratories. Vancomycin disk diffusion method for S . aureus and lack of proper penicillin susceptibility test for S . pneumoniae were still common cause of inaccurate results. Virtual microscopic survey has been successfully introduced in parasitology.
(J Lab Med Qual Assur 2015;37:153-178)
Keywords : Proficiency survey, Parasitology, Bacteriology, Clinical microbiology, Mycobacterial culture, Susceptibility testing
  1. Jones RN, Glick T, Sader HS, Flamm RK, Ross JE, Rhomberg PR, et al. Educational antimicrobial susceptibility testing as a critical component of microbiology laboratory proficiency programs: American Proficiency Institute results for 2007-2011. Diagn Microbiol Infect Dis 2013;75:357-60.
    Pubmed CrossRef
  2. Snell JJ, Brown DF, Perry SF, George R. Antimicrobial susceptibility testing of enterococci: results of a survey conducted by the United Kingdom National External Quality Assessment Scheme for Microbiology. J Antimicrob Chemother 1993;32:401-11.
    Pubmed CrossRef
  3. Chaitram JM, Jevitt LA, Lary S, Tenover FC; WHO Antimicrobial Resistancce Group. The World Health Organization's External Quality Assurance System Proficiency Testing Program has improved the accuracy of antimicrobial susceptibility testing and reporting among participating laboratories using NCCLS methods. J Clin Microbiol 2003;41:2372-7.
    KoreaMed CrossRef
  4. EUCAST. Breakpoint tables for interpretation of MICs and zone diameters
    ( ' target="_blank">"> Accessed January 1, 2014).
  5. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: 24th informational supplement, M100-S24. Wayne (PA):Clinical and Laboratory Standards Institute, 2014.
  6. Spellerberg B, Brandt C. Special phenotypic methods for detecting antibacterial resistance. In: Swenson JM, Patel JB, Jorgensen JH, editors. Manual of clinical microbiology. 10th ed. Washington (DC): ASM press, 2011;1168.
  7. Ko YJ, Kim MN, Kim EC, Shin JH, Lee NY, Kim S, et al. Annual report on external quality assessment scheme in clinical microbiology in Korea (2013). J Lab Med Qual Assur 2014;36:122-39.
  8. Kim MN, Shin JH, Sung H, Lee K, Kim EC, Ryoo N, et al. Candida haemulonii and closely related species at 5 university hospitals in Korea: identification, antifungal susceptibility, and clinical features. Clin Infect Dis 2009;48:e57-61.
    Pubmed CrossRef
  9. Ng LS, Sim JH, Eng LC, Menon S, Tan TY. Comparison of phenotypic methods and matrix-assisted laser desorption ionisation time-of-flight mass spectrometry for the identification of aero-tolerant Actinomyces spp. isolated from soft-tissue infections. Eur J Clin Microbiol Infect Dis 2012;31:1749-52.
    Pubmed CrossRef
  10. Lee H, Koh EM, Kim CK, Yum JH, Lee K, Chong Y. Molecular and Phenotypic Characteristics of 16S rRNA Methylase-producing Gram-negative Bacilli. Korean J Clin Microbiol 2010;13:19-26.
  11. Jung S, Yu JK, Shin SH, Park KG, Jekarl DW, Han K, et al. False susceptibility to amikacin by VITEK 2 in Acinetobacter baumannii harboring armA. Ann Clin Lab Sci 2010;40:167-71.
  12. Cavaco LM, Aarestrup FM. Evaluation of quinolones for use in detection of determinants of acquired quinolone resistance, including the new transmissible resistance mechanisms qnrA, qnrB, qnrS, and aac(6')Ibcr, in Escherichia coli and Salmonella enterica and determinations of wild-type distributions. J Clin Microbiol 2009;47:2751-8.
    Pubmed KoreaMed CrossRef
  13. Mammeri H, Guillon H, Eb F, Nordmann P. Phenotypic and biochemical comparison of the carbapenemhydrolyzing activities of five plasmid-borne AmpC 棺-lactamases. Antimicrob Agents Chemother 2010;54:4556-60.
    Pubmed KoreaMed CrossRef
  14. Lee K, Lee M, Shin JH, Lee MH, Kang SH, Park AJ, et al. Prevalence of plasmid-mediated AmpC beta-lactamases in Escherichia coli and Klebsiella pneumoniae in Korea. Microb Drug Resist 2006;12:44-9.
    Pubmed CrossRef