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Recommended standards for modern tuberculosis laboratory services in Europe

¹ HPA National Mycobacterium Reference Unit and Clinical TB and HIV Group, London, UK. ² Swedish Institute for Infectious Disease Control, Stockholm, Sweden. ³ Forschungszentrum Borstel, Borstel, Germany. ⁴ National TB Institute, Riga, Latvia. ⁵ Statens Serum Institut, Copenhagen, Denmark.

CORRESPONDENCE: F. A. Drobniewski, Health Protection Agency National Mycobacterium Reference Unit, Head Clinical TB and HIV Group, Centre for Infectious Diseases, Institute for Cell and Molecular Sciences, Barts and the London School of Medicine, Queen Mary College, 2 Newark Street, London E1 2AT UK. Fax: 44 2075393459. E-mail: f.drobniewski{at}qmul.ac.uk

Keywords: Culture, guidelines, microscopy, molecular testing, training, tuberculosis

Received: June 28, 2006
Accepted August 1, 2006

The principles underpinning these standards are that any tuberculosis laboratory-based diagnostic procedure should be performed by appropriately trained staff, working to standardised operating procedures in appropriately equipped and safe laboratories, against clear national and international proficiency and quality standards. Quality should be the pre-eminent criteria, not cost.

The standards are technologically feasible, but initially may not be within the financial capacity of all laboratories. There is a requirement for government and international donors to adequately fund an appropriate safe infrastructure to enable staff to deliver accurate and timely results at whatever level of activity they are performing.

There is a need for national reference laboratories to train a new cadre of mycobacterial laboratory experts. This will require the funding of appropriate individuals at these centres to train and assist in the implementation of good laboratory practice and evaluation to build sustainable capacity. Further operational research is needed to establish the optimal configuration of new technologies to determine isoniazid, rifampicin and second-line drug susceptibility in mycobacterial cultures and also, increasingly, directly on specimens.

Improved integration of laboratory medicine as a core part of all tuberculosis programmes is needed to achieve and maximise the potential of new developments.

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