title: Quality assurance programme for drug susceptibility testing of Mycobacterium tuberculosis in the WHO/IUATLD Supranational Laboratory Network: first round of proficiency testing.
abstract: METHODS
  Quality assurance of the WHO/IUATLD global tuberculosis drug resistance surveillance programme.
  
  
  OBJECTIVE
  To perform a proficiency test of drug susceptibility procedures within the WHO/IUATLD network of supranational reference laboratories (SRL).
  
  
  METHODS
  Identical culture panels consisting of 20 clinical isolates of Mycobacterium tuberculosis containing both drug susceptible and drug resistant cultures were tested by the 16 laboratories of the network for resistance to streptomycin, isoniazid, rifampicin and ethambutol. The drug susceptibility testing procedures included the proportion, absolute concentration and resistance ratio methods as well as their variants, including the radiometric BACTEC 460 method.
  
  
  RESULTS
  The first round of proficiency testing has shown that the specificity of drug susceptibility testing within the SRL network was significantly higher than its sensitivity. The testing of isoniazid and rifampicin shows a high degree of agreement between the labs, but discordant results can be obtained with streptomycin and ethambutol.
  
  
  CONCLUSIONS
  Drug susceptibility procedures for the testing of isoniazid and rifampicin, the two anti tuberculosis drugs which define multidrug-resistant tuberculosis, are highly reliable within the SRL network. Procedures for drug susceptibility testing of streptomycin and ethambutol are still in need of standardization.
authors.affiliation: Laboratory Centre for Disease Control, Health Canada, Ottawa, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Laszlo
authors.forename: M
authors.initials: M
authors.lastname: Rahman
authors.forename: M
authors.initials: M
authors.lastname: Raviglione
authors.forename: F
authors.initials: F
authors.lastname: Bustreo
mesh_terms: D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002984:Clinical Laboratory Information Systems; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007538:Isoniazid / Q000009:adverse effects / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D011159:Population Surveillance; D011785:Quality Assurance, Health Care; D012293:Rifampin / Q000009:adverse effects / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D013307:Streptomycin / Q000009:adverse effects / Q000627:therapeutic use; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology; D014944:World Health Organization
chemical_list: D000995:Antitubercular Agents; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin