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
One of the advantages of a central lab is that it has the flexibility to reassign staff and resources to deal with problems when they become acute. A review of clinical reference labs is being carried out by the HSE, according to Holohan, who added that a central reference laboratory is the “kind of thing that [might] emerge out of a review”.
One reference lab that didn’t wait for Government funding is the National Cystic Fibrosis (CF) Microbiology Reference Laboratory in Tallaght Hospital. Since 1999, this service has been funded by the charity Cystic Fibrosis Ireland and run by consultant microbiologist Prof Philip Murphy.
The need for this service arose when a particular strain of bacteria, called Burkholderia cepacia, “was spreading everywhere”, according to Murphy. “The real requirement for a reference laboratory is that you can’t distinguish those species in an ordinary conventional way.”
Since then, the lab has expanded its portfolio to include another type of bacteria, Pseudomonas aeruginosa, which is present in about 30 per cent of people with CF in Ireland. They receive about 1,000 samples from hospitals here each year which Murphy says saves the State about €250,000.
A 2009 report commissioned by the HSE on services for people with cystic fibrosis recommended that the HSE working group on reference laboratory facilities “should consider the need for a designated reference facility service for cystic fibrosis as a priority”.
The report also recommended that the service at Tallaght Hospital “should be supported” until the working group rules on the location of a designated reference facility service for cystic fibrosis. Despite applying for Government funding on many occasions, the CF reference lab continues to be funded by Cystic Fibrosis Ireland.
A resistant form of Pseudomonas aeruginosa was one of the bacteria included in one of the most recently published guidelines from the Health Protection Surveillance Centre. These guidelines for the prevention and control of particular forms of antibiotic resistance including CPEs and Pseudomonas aeruginosa, recommend that more national reference lab services are established for these bacteria. “The development of microbiology laboratory reference services specialised in the identification and more detailed characterisation of these organisms in Ireland is . . . an urgent requirement.”
One strain of bacteria that the guidelines apply to is vancomycin-resistant enterococci (VRE). Ireland has the highest incidence of VRE in Europe, yet lacks a reference lab service for it. Vulnerable people such as those on chemotherapy are at risk of getting infections that are difficult to treat if they pick up VRE, as commonly used antibiotics do not work on it. VRE caused 176 bloodstream infections last year, just 46 fewer than MRSA.
Since these guidelines were published in 2012, the CPE reference lab in Galway was established but many gaps remain in the overall Irish service. Labs in the UK continue to receive a steady stream of post from Irish hospitals.
Bacterial resistance in Ireland
In 2012 (latest European data), 44% of the gram-negative bacteria Enterococcus faecium isolates in Ireland were resistant to vancomycin. That is the highest percentage of resistance in the 30 European countries monitored by the European Centre for Disease Control. It is almost double the resistance of the next-highest country, Portugal (23.3%)
In 2013 (latest Irish data), this figure was still high, at 43.1%