Special delivery: Microbes fresh from Ireland
As there are not enough reference labs in Ireland, samples have to be sent to up to 11 locations in the UK
A central lab in Ireland would mean having the flexibility to reassign staff and resources to deal with problems when they become acute.
What happens to the samples you give in hospital? Patients are routinely asked to give samples of urine, sputum and blood. After a few hours, or sometimes a few weeks, you get the results. In the meantime, the bugs often go on a journey to different corners of Ireland or the UK. The samples are first tested by hospital laboratories but if a particular infection or disease is suspected, they are sent to reference labs that use more sophisticated equipment. These complete additional analysis including genetic testing.
Though a number of reference labs have been established here, Irish hospitals still post samples to 11 locations in the UK. The most recent version of the Public Health Laboratory’s Clinical Microbiology User Manual lists 115 reference lab tests. Just over 40 per cent of these tests can be completed here, and the rest are done in the UK.
“From a strategic point of view, it is clear that we need more reference capacity at a national level for different bugs,” says Dr Tony Holohan, the chief medical officer at the Department of Health. “We have many labs in the system so there’s a question about how we can reorganise our resources to ensure that we develop the national capacity that we need.”
Martin Cormican, professor of bacteriology at NUI Galway, is the director of two national reference laboratories in the university. He doesn’t think “one would reasonably expect a laboratory in the UK, which is there to primarily serve England, to drop everything if there’s a problem in an Irish hospital”. He says one advantage of having a national service is that their priority is to support the labs here. His labs conduct additional tests, help hospitals decide on the best treatment options for a patient, analyse outbreaks and provide data to policy makers.
Reference labsIn 2001, it was reported that “a network of reference laboratories does not exist for the majority of pathogens”. In the Strategy for the Control of Antimicrobial Resistance in Ireland (SARI) report, establishment of a network was a priority recommendation. Since then a small number of reference labs have been established including the MRSA reference lab in St James’s Hospital in 2002 and NUI Galway’s Carbapenemase Producing Enterobacteriaceae (CPE) reference lab in 2012.
“It was recognised at a national level by the HSE that it was necessary to have a process for confirming whether a [hospital] lab thought it had something that was a CPE,” says Cormican. Funding the CPE lab costs €70,000, which covers the salary of a scientist and consumables.
Cormican says carbapenemase-producing enterobacteriaceae (CPE), also known as carbapenem-resistant enterobacteriaceae (CRE), are bacteria that are often resistant to a large number of antibiotics, including carbapenems.
Meropenem is one of the best known antibiotics in this group. “Ten years ago, if someone was pretty ill and wasn’t getting better on the antibiotic you were using, you could count on meropenem. That was our reserve drug and you can’t count on it anymore because of CPEs.”
Though some samples can be complete in Ireland, most tests need to be conducted in the UK. Public Health England, Colindale, is one of 11 UK locations to which Irish samples are sent. Since January 2012, it has received 1,786 isolates of bacteria grown from Irish hospital samples. Colindale would not release how much it charges Irish hospitals for this service, citing commercial sensitivities. However, a microbiologist based in a Dublin hospital said it cost €190 for each isolate processed by Colindale. So it can be estimated this service from just one UK reference lab costs more than €140,000 every year.