New Training Course for Latin American and Caribbean Veterinary Labs Results in Stronger Standards, Safer Food

CLSI recently partnered with the Ohio State University (Ohio State) and the Inter-American Institute for Cooperation on Agriculture (IICA) for the first training of its kind that brought together official veterinary diagnosticians in Latin America and the Caribbean (LAC) working in national reference labs monitoring antimicrobial resistance (AMR). This training has the potential to create greater harmonization of standards and practices for farm-to-table AMR surveillance and management in veterinary and food safety labs. Laboratories in 12 countries across LAC participated in the training, with participation from labs in 18 more countries planned for the future.

Veterinary AMR and human health are intricately connected, as bacteria can be transmitted from animals to humans through direct contact or the food chain. When animals are slaughtered and processed for food, antimicrobial resistant bacteria can contaminate meat or other animal products. Humans can contract infections, including antimicrobial-resistant infections, by handling or eating contaminated food.

We spoke with Armando E. Hoet, DVM, PhD, Dipl ACVPM of the Department of Veterinary Preventive Medicine and Dubraska V. Diaz-Campos, DVM, PhD of the Department of Veterinary Clinical Sciences, both in the College of Veterinary Medicine at Ohio State about the collaboration between the school, IICA, and CLSI to create the first edition of the course Antimicrobial Susceptibility Testing (AST) Introductory Training Using CLSI Standards for Small Diagnostic Laboratories or With Limited Resources.

The need.

Ohio State has been working with IICA since 2011 on global food production systems and AMR. As they developed surveillance plans for countries in LAC, they recognized that there was a need for better training for official veterinary diagnosticians working in national reference laboratories. While the majority of these public officials encountered were familiar with CLSI standards, they didn’t necessarily know how to properly use and implement them, and they didn’t have the most up-to-date information, with some of them using CLSI standards from 15-20 years ago.

“I have been working with CLSI since 2016 and I have been a member of the American Association of Veterinary Laboratory Diagnosticians (AAVLD) since 2012,” Dr. Diaz-Campos said. “Every year, the American Association of Veterinary Laboratory Diagnosticians (AAVLD) organizes the Inter-laboratory Bacteriology Quality Assurance Survey (IBQAS); it’s similar to proficiency testing. Veterinary diagnostic labs receive 4-5 bacterial isolates with clinical history and the participant laboratories are asked to perform susceptibility testing on at least one isolate. Over the years, we have noticed that some laboratories here in the US have some issues when doing the testing or reporting some of these isolates. Armando, working on the international side and me working here internally, we got into these conversations about how we could better educate labs to apply the guidelines and standards not only for clinical applications, but also for AMR surveillance.”

Course design and development.

It took almost a year and a half to design and develop the training, after which the hybrid course was created in an online platform on the IICA website. Training began in June of 2023 in 12 countries that were each represented by the official reference veterinary diagnostic lab for their respective country. The countries that participated in the original round of training were:

• Argentina
• Belize
• Chile
• Colombia
• Costa Rica
• Ecuador
• El Salvador
• Honduras
• Jamaica
• Mexico
• Nicaragua
• Trinidad and Tobago

Eighteen additional LAC countries will participate in the second edition of the training next year. Participants were able to obtain the videos and other educational materials (in both English and Spanish) two weeks in advance of in-person sessions that took place on Fridays. During the live Friday sessions, several CLSI members, as well as other specialists, were available to interact with course participants in real time and clarify questions, doubts, or issues that they observed in the asynchronous sessions. These live sessions lasted from 1.5-2 hours and were simultaneously translated into English and Spanish.

The training took participants through sample or isolate receipt, all the way to interpretation, QC, and QA. Every CLSI standard that was referenced in these steps was used for training materials and discussed more in depth during the live weekly meetings. For example, CLSI VET01, CLSI VET02, CLSI VET03, CLSI VET04, and CLSI VET05 each have either their own individual video dealing with a particular section, or were used as elements of the training. As training became more in depth, minimal inhibitory concentration (MIC) testing and Kirby-Bauer testing were covered, as well as individualized confirmatory tests that many participants had not covered before. AAVLD recommendations, as well as ISO, and some other international recommendations were also used to complement the CLSI material.

“A fellow CLSI member asked me why we were working on this when there are already online courses about how to do susceptibility testing,” said Dr. Diaz-Campos. “I just said that our course was kind of unique. Number one, we created it in Spanish and English and second, we have the synchronous activities, so the participants were encouraged to review all of the material and then bring questions they had to us. Finally, every time they completed a module, they had to think about what they learned and how they were going to apply what they learned. They needed to send that in written format to us and be prepared to give us questions for every Friday when we got together. I think that made this training unique. And I think that people really enjoyed getting together with us as we tried to answer their questions.”

The impact on food safety laboratories.

The third edition of this training will expand later in 2024 to food safety laboratories, as in many countries, food safety diagnostic laboratories are part of their national AMR surveillance programs at the point of sale. This training will be done in association with the Pan American Health Organization (PAHO) which is part of the World Health Organization (WHO).

When asked about how the training could benefit food safety laboratories, Dr. Hoet said, “When you’re doing integrated surveillance for AMR from farm to table, for most of the veterinary diagnostic labs, their jurisdiction is limited to the farm or, at best, the slaughter plant. Nevertheless, for a surveillance system to be complete, you need to sample raw products of animal origin at the supermarket, so you can determine what kind of microorganisms (and their resistance) are really going to the customer. However, that chicken, meat, or any other food product will be tested by a food safety lab. Therefore, if we really want to support full surveillance in the agricultural sector, we also need to train food safety labs in these standards, so results could be comparable between what we’re finding in farm and slaughter plants and what we’re finding at the point of sale in the supermarkets.”

There are many different types of laboratories providing testing for AMR surveillance programs. Some of these data in different countries are provided by veterinary diagnostic labs and some are provided by food testing labs. Dr. Diaz-Campos said, “If we are not using or implementing the susceptibility testing as it should be and doing the interpretation properly, some of the data that we provide to these surveillance programs might not be as good as they should be. I think that one of the key things for me is that it’s very important that we harmonize our methods as much as possible. For example, when we apply breakpoints to E. coli that’s coming from a dog, we call it resistant for certain drugs, but then if we use the human breakpoint, the antibiotics may be considered susceptible. This is an issue that creates some problems when we provide data for surveillance programs. Providing updates and education in laboratories about what data you should provide to surveillance programs is important. Laboratories must understand how they need to, even when it’s the same isolate, same type of bacteria, same bacteria species, do different types of interpretation based on the application of the test. It’s very important.”

This CLSI training covered more countries, and covered more in-depth information, than any previous Latin American CLSI course. Participants were asked how many of them had received CLSI training previously, and more than 98 percent of the participants had never participated in a CLSI training.

Dr. Hoet noted “CLSI was very supportive. We were able to include a hard-copy collection of the CLSI standards and guidelines used for the training to every single veterinary AST official lab that participated because CLSI provided a major discount on these products to us. We strongly believe that by providing access to the most up-to-date CLSI manuals, we will significantly contribute to the validity and quality of the AST data generated in the region.”