Microbiology Laboratory Workflow optimization

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1 NORDIC EDITION SEPTEMBER 2015 Microbiology Laboratory Workflow optimization ECCMID 25 th European Congress of Clinical Microbiology and Infectious Diseases biomérieux in Veterinary Diagnostics VIDAS 3 at Prostataklinikken in Oslo

2 Dear customer In the last edition, Sascha Przybilla, General Manager biomérieux Nordic countries, used the J.F. Kennedy quote change is the law of life. I will continue in this spirit to let you know that biomérieux have decided to create clusters within our commercial operations. One of these clusters is Northern Europe, which includes the Nordic Countries, the UK, Ireland and Benelux. I am now the manager of this cluster, at the same time as being General Manager for the Nordic Countries and the UK. The objective behind the creation of the clusters is to reinforce our interaction with you, to become more pro-active in supporting you through the consolidation of the expertise of our different teams. I hope that you will see the positive effects over the next few months., After four successful years based in Sweden, Sascha Przybilla has been given the opportunity to return to his home country and becomes the General Manager of Germany. I have asked Juha Miller to be the Clinical Commercial manager covering Sales and Customer Service and Charmain Kanstrup to be the Industry Sales manager. In this issue of mynews, we give an early look at our Performance Solutions: elearning, which we have just launched to offer you an extensive training catalogue covering technical, management and personal development topics. Workflow optimization, in order to help you improve the efficiency within your laboratory. The new version of Labguard, which offers full monitoring of your environment. You can also read about the role of our new immuno assay platform, Vidas 3, and the PSA test in the first diagnostic centre for prostate cancer, as well as the testimonies of two veterinary laboratories regarding the use of biomèrieux solutions. Contents Editorial... 2 Launch of biomérieux elearning... 3 biomérieux in Veterinary Diagnostics... 4 Microbiology Laboratory Workflow Optimization... 7 Project Citizen-oriented Diagnostics... 9 The Labguard 3D monitoring solution Legionella VIDAS 3 at prostataklinikken in Oslo Bacillus cereus ECCMID Contact information Exhibition participation biomérieux Nordic training offer I hope you will enjoy reading this new mynews issue. HEAD OFFICE biomérieux Sweden AB Hantverksvägen 15 SE Askim Sweden Phone: EDITING Katarina Bredberg Leena Tiikkaja Jean-Louis Tissier VP Northern Europe contact.nordic@biomerieux.com Form och layout: In Time Tryck: Majornas Grafiska 2

3 Launch of biomérieux elearning biomérieux is happy to announce the launch of elearning for Nordic customers via the increaseyourperformance.com webpage. biomérieux takes pride in our high level of scientific knowledge and in our quality products within the field of microbiology. We recognize the importance of knowledge and understanding for the proper use of our products, and for securing high quality results towards the patients. We value education and strive to provide you with a portfolio to match your needs. biomérieux offers training on-site, at training centers and, now, also on-line. In collaboration with Mérieux University, we have developed an extensive training catalogue covering not only diagnostics but also management and personal development. The training covers three main areas. INSTRUMENTS AND SOFTWARE The product trainings are developed by biomérieux expertise and cover our different product areas. The knowledge assessments can be used as a tool to assess your staff s possible training needs, or to evaluate a completed course. SCIENCE AND PRACTICES The scientific courses provide knowledge on the science behind the samples, diseases and micro organisms. This can be used to bring people with different backgrounds to a similar level of knowledge within a field. It is perfect for new staff and students. PROFESSIONAL DEVELOPMENT The professional development trainings are developed by external experts, biomérieux s long-established trusted partners, renowned in their field. The trainings can help you to develop in different management skill areas, such as successful recruitment, conflict handling, staff motivation, fundamentals of finance and many others. We offer a total of 22 different courses covering a wide variety of subjects that are essential for every manager s success. In the elearning, biomérieux has put focus on the quality of teaching. Not every expert is also an expert teacher but ours are. The elearning makes it possible to receive trainings and achieve product certification online: Anytime and anywhere in the laboratory, in the office or at home Expertly designed At your own pace the trainings can be stopped and restarted Dynamic, with short 20-minute modules With dedicated knowledge assessment tools to monitor and develop competencies in your organization To find out more visit: FOR MORE INFORMATION: Sara Williamson Customer Service Manager sara.williamson@biomerieux.com 3

4 biomérieux has, since a couple of years, a specific franchise for Veterinary Diagnostics. We took the opportunity to visit two veterinary laboratories in Sweden using the biomérieux solutions. AUTHOR: Katarina Bredberg, Industry Product Manager, katarina.bredberg@biomerieux.com biomérieux in Veterinar Anicura Västra Djursjukhuset We visit the hospital laboratory at Anicura Västra Djursjukhuset, in Gothenburg, and meet the laboratory manager Helena Karlström, a certified biomedical analyst and also a certified veterinary nurse and her two colleagues Jill Strömberg and Helena Lundström. The laboratory is equipped for clinical chemistry, hematology, bacteriology, cytology, parasitology, mycology and endocrinology analyses. Bacteriology is a major part of the laboratory activity, as all laboratory technicians who work here have a background at human bacteriology laboratories. With this experience, and a special enthusiasm for the field, the lab has become a center of excellence of veterinary bacteriology. Helena Lundström, Jill Strömberg and Helena Karlström in the lab. Even though the laboratory is large by veterinary hospital standards, with three full time technicians, it is a tiny organization compared to the hospital laboratories for humans. (JS): In a small lab like this we get to use everything we have learned. We all work in all the different areas every day. This is one reason why it is so interesting and developing to work here. (HL): Another big difference is that here you work close to the patient. In 2014, Anicura Västra Djursjukhuset implemented the VITEK 2 Compact for automatic identification and antibiotic susceptibility testing. (JS): The work in our laboratory has improved in several ways since we implemented the VITEK 2 Compact. The different work flow and the short time to results compared to manual methods, have made a big difference to how we work. The work is now much more structured, but at the same time more flexible. We would not want to go back to manual methods again - we would not have the time! Now the results are always ready in the morning, waiting for us when we arrive at the lab. (HK): The biggest change has been the boost to competence and knowledge following the new method. The implementation of VITEK 2 Compact was an incentive for us to refresh our knowledge of antibiotic susceptibility testing, and we have learned a lot since we got the new instruments. (JK): With the VITEK 2 Compact and our expertise we can help our customers so much more, with adapted answers and extra information on resistance patterns and antibiotics. This is also important in the work to reduce the use of broad spectra antibiotics. (HK): Initially the implementation was a challenge, to put everything in place and to learn and understand everything. We received excellent help from the biomérieux application support team, especially Sara Williamson. She was great! She did a fantastic job with the set up and implementation of all the rules. (HL) The VITEK 2 Compact instrument is really stable and reliable, it never gives trouble or causes alarms. This makes it very easy to work with on a daily basis. Before we leave, what is the best thing with working at an animal hospital lab? (HK): Being able to combine all you learned at the education with your greatest interest! (JS): Having your best friends, your pets, with you at work. (HL): For me, the best things are my colleagues. 4

5 y Diagnostics Evidensia Djursjukhuset Malmö We meet the head of the laboratory at Evidensia Djursjukhuset in Malmö, Dr. Dusan Jankovic: 4 people work in the lab at the moment. We perform analysis on samples from dogs and cats, and also some from horses and exotic animals. We mainly perform analysis within clinical chemistry, cytology and parasitology, but are also work with some molecular and microbiological methods. The advantage of having the progesterone testing in our own lab is that we can have the final result and a recommendation for the owner just a couple of hours after the dog has come to us. Dr. Jankovic is also responsible for the reproduction department of the hospital, and he tells us enthusiastically about his work with dog reproduction. When a dog owner comes to us with the dog he wants to breed, we carry out tests and examinations to determine the best time for mating or insemination. We do a progesterone test on a blood sample to establish the exact progesterone level, and we do a cytological examination. With this information and our experience and expertise we can advise the owner exactly when it is time. We had 300 reproduction patients last year, and 85% of those got pregnant, which is a fantastic result! Dr. Jankovic and biomérieux Application Specialist Petronella Steen. Why did you chose minividas for your progesterone testing? I have worked with reproduction for many years in Italy, Germany and France, and have seen minividas being used for progesterone testing since the 1990 s. There was never really a question about it, minividas was the only option for me. The instrument is very reliable and easy to use, without any time consuming startup procedures. We installed the VIDAS in your lab two years ago. How did you find the implementation process? It was really quick! The installation was done in a couple of hours, and thanks to Petronella s excellent training, we were using the instrument for patient samples only a few days after installation. Now everyone working in the lab uses the instrument, and, as an extra bonus, we also use it for T4 and cortisol testing. What is the best thing with your job? New puppies! And good feedback from the breeders. 5

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7 Microbiology Laboratory Workflow Optimization in the Satadiag clinical microbiology laboratory Laboratories in both the clinical and industrial fields are faced with the challenges of providing faster results, maintaining quality in an increasingly regulated environment and ensuring their staff continue to be motivated while developing new skills and competences. At biomérieux we understand these challenges and we have developed a range of new services to help our customers meet them. PEOPLE INCREASE PRODUCTIVITY PROCESS Workflow optimization is one of these services and is a part of the biomérieux Performance Solution platform. Through assessing how the laboratory deals with its daily workload, recommendations can be made as to how improvements in efficiency can be effected. Workflow optimization combines continuous improvement management techniques like Lean Six Sigma and Kaizen. The main goals of Workflow Optimization for the lab are: Streamlining processes to improve lab efficiency Increasing productivity to absorb larger workloads with improved time to results Reducing laboratory s costs and/or being able to invest in new technologies RAPID CLINICAL DECISION SUPPORT TECHNOLOGY REDUCE ERRORS Reallocating staff to more added value tasks In 2013, a workflow optimization service was carried out in the Satadiag clinical microbiology laboratory in Pori. This article is written based on the thoughts and reflections of Head Doctor Raija Manninen, Manager of the microbiology laboratory. Based on Raija Manninen s investigation of workflow optimization service providers, biomérieux is the only major 7

8 International expertise and observation will produce fresh ideas and proposals for process evaluation and modification. Raija Manninen company offering specific optimization services for microbiology laboratories that also has strong microbiology knowhow and a global perspective. VITEK MS The initial reason why Dr Manninen started looking into workflow optimization was the implementation of the MALDI-TOF technique (VITEK MS) in the laboratory. This new technique, with its low hands-on time and short time to result, opened up for increased productivity in the lab. Traditionally, sample reading is done in the morning and additional tests are carried out in the afternoon. The laboratory layout was not optimal for the workflow and one factor which needed adjustment were the spread out workstations, which caused excessive transportation and movements, which in turn caused a non-communicative and ineffective work environment. The two person reading procedures were also ineffective and induced a high administrative load. In addition, the rapid testing area also needed re-positioning. LABORATORY LAYOUT MODIFICATION One of the major changes resulting from the workflow optimization service was better utilization of laboratory floor space and layout says Dr. Manninen. This was performed by redesigning the workstations and investing in new lab benches in such a way that construction work or rebuilding was not needed. Sample pathways were streamlined to avoid unnecessary movements and to make the sample flow continuous from arrival to waste. Based on the optimization, the laboratory workstations were divided into six different sections: sample arrival and registration station, rapid testing station, culture station, incubation station, reading station and ID/AST station. The urine culture plate reading was converted from single morning reading to three readings per day, after exactly 18 hours of incubation. This provided faster results to patients and also streamlined the plate handling procedures. The laboratory s staff reallocation and merged workstations produced a more efficient work atmosphere where laboratory technicians can discuss and consult each other during reading and interpretation. Remodeling of the workstations also led to an enhanced work environment with merged instrument space where noise levels can be controlled. OBSERVATION DURING THREE DAYS The initial step in the optimization was observation of the current work flow. The daily routines of the laboratory were observed over three days. A written report and report-out session was held on the fourth day. The workflow optimization team included three international consultants and a local biomérieux representative, in this case the application specialist. Dr. Manninen was very pleased with the whole process and said it helped her to gain trust for changes to come. The fast results and analysis of the service, and that the report was informative and easy to understand were also highly appreciated. We asked Dr. Manninen why laboratories should consider this workflow optimization service. Finland is a small country and the exchange of knowledge and methods is quite limited. International expertise and observation will produce fresh ideas and proposals for process evaluation and modification. Automation will bring the need to modify the processes in the laboratory. Laboratories which are evaluating expanding microbiological services to cover evenings and/ or nights (24/7 model) could also benefit greatly from such a service. AUTHOR: Tommi Timoharju Account Manager, Clinical Bacteriology tommi.timoharju@biomerieux.com 8

9 Project Citizen-oriented Diagnostics The project group explains: One third of all fertile women in Sweden have low iron blood values and many of them are not aware of it. At Capio Berga primary health care center there is an ongoing collaboration with the Clinical Chemistry laboratory at Linköping University Hospital. The project goes under the name citizen-oriented diagnostics and aims to bring health investigations closer to the effected persons. The focus of the group is iron and vitamin-d deficiencies, which are common, but in many cases unknown problems among women. If we can discover and treat these deficiencies earlier, it can lead to better health and prevent future illnesses. With the small bench instrument minividas we can move from centralized analyzes, to a near-patient analysis and a citizen-oriented diagnostics. Capio Berga primary health care center has invited healthy women between years, to get their iron storage investigated. In 40 minutes meetings, the women have their iron storage levels investigated, and get an action plan to improve the values if needed. The combination of immediate test results and a direct follow up meeting is the real strength of the citizen-oriented diagnostics. As a next step, minividas is now being evaluated to run vitamin D test for a similar concept. Vitamin D deficiency can lead to osteoporosis in the long run. Student Emma Börjesson is in a study comparing minividas results with results on the existing vitamin D analysis at the central laboratory. Göran Schedvin, Cecilia Hedberg och Emma Börjesson FOR MORE INFORMATION: Teresa Gunnarsson Clinical Product Manager teresa.gunnarsson@biomerieux.com Find out more: 9

10 The Labguard 3D monitoring solution A new generation of hardware with a new interactive design biomérieux has launched a new version of the Labguard monitoring solution for temperature and other physical parameters, such as humidity, CO 2 and differential pressure. The new Labguard 3D features a 360 overview with projected visual alarms, an interactive and integrated multifunctional display, universal sensor connectivity and automatic sensor detection. The solution comes with real-time communication and data logging. 10

11 The Labguard 3D solution contributes to the safety, quality and regulatory compliance of the laboratory, and is ISO 17025, ISO 15189, and 21CFR PART 11 compliant. It gives total control over storage and environmental conditions with advanced metrology and robust mobility solutions. It has real-time alerts and 24/7 connectivity with wireless-access software and flexible hardware. The laboratory saves energy, time and costs, and can focus on value-added work. The RADIO RECEIVERS have USB or Ethernet connection. USB-Ethernet adapters are always included. The SOFTWARE is flexible and meets the advanced needs of any laboratory. The flexible and secure web-based Labguard 3D software makes environmental monitoring easy from anywhere, using one universal license. Real-time alerts can be sent via multiple media. The complete traceability of all Labguard 3D operations can be exported with the audit trail functionality to meet accreditation and regulatory requirements using the access to a professional postgresql database. Labguard 3D has a MOBILITY range with secure, robust and innovative solution for continuous monitoring during transport. The HARDWARE is innovative and easy-to-use. It is scalable to suit the laboratory requirements, including sensors with up to four universal inputs. The scalable options include radio and Ethernet transmitters and receivers. The SENSORS are numeric with unique ID numbers. We offer a large range of plug and play sensors. ISO calibrated sensors are available on request. The metrology certificates are embedded in the sensors. The RADIO TRANSMITTERS are available with or without displays and with options of 1, 2 or 4 universal inputs. They can be run on lithium battery, USB or main power supply. The ETHERNET TRANSMITTERS have displays and 4 universal inputs. They are powered via USB or main power supply. METROLOGY SERVICES AND EQUIPMENT We offer a complete range of thermostatic chambers with internal instrumentation and calibration services. ISO accredited services and traceable metrology are also available according your needs. SERVICES We offer a full-range of Labguard 3D services that ensure reliability of protocols and equipment for long-term quality assurance. You gain full confidence and continual improvement in your quality assurance. FOR MORE INFORMATION: Göran Jacobsson Nordic Business Manager Clinical Division goran.jacobsson@biomerieux.com TECHNICAL PRODUCT INFORMATION wwww.mybiomerieux.com biomérieux offers a free online service with all the latest product documentation on mybiomerieux.com. Here you can find manuals, package inserts, quality control certificates, material safety data sheets and declaration of conformity statements. You can get your free access on mybiomerieux.com. If you are not already a user you can easily sign up for an account by following the instructions under Create an account. After you have created the account an activation with a link will be sent to you. 11

12 Legionella Legionella is a gram-negative facultative intracellular bacteria, which got its name from an outbreak in Philadelphia The American Legion, a veterans association, had a convention at the Bellevue-Stratford Hotel, when 182 of the delegates contracted the, then unknown, disease, of which 29 died of the illness. The causative bacteria was identified several months later and named Legionella pneumophilia. The disease was named legionellosis and is also commonly called Legionnaires disease, or Legion fever. Today, Legionellosis has a fatality rate ranging from 5 % to 30 %, where hospital acquired infections with Legionella have a fatality rate close to 30 %. Other species of the genus such as L. longbeachae and L. feeleii cause Pontiac fever, a less severe infection. Until now, roughly 50 Legionella species and 70 serotypes have been described. The majority of the species have been isolated both in humans and in the environment, and 20 of those have been confirmed as causing disease in humans. In the natural environment, Legionella is usually resident in amoebae where it lives and prospers. Occasionally it leads to outbreaks but most often humans get infected in single incidents. Legionella can spread from human to human but infection is primarily through environments linked to various water systems, such as air conditioning, spas, hot springs, ice machines, swimming pools and water treatment systems. Transmission to humans occurs primarily through inhalation of contaminated aerosols but can also occur through wound infections (nosocomial infections). If you get infected by L. pneumophilia the symptoms are initially general, with a headache which later develops into high fever and fever chills. As the illness develops further, the respiratory functions become affected with coughing, shortness of breath and pain in the lungs. For those infected with other species of Legionella that give Pontiac fever, the symptoms are milder and very much like influenza; headache, fever and muscle pain. 12

13 LEGIONELLA DIAGNOSTICS Diagnosis of Legionella is most often done through a diagnostic algorithm covering several methods; culture of clinical specimen, urinary antigens, direct immunofluorescence, PCR and now also Maldi-ToF Mass Spectrometry. URINARY ANTIGENS A rapid test based on antigen detection brings high clinical value. It gives rapid results with high sensitivity, and specificity at the same level as cultures. The drawback is the limitation to only detecting L. pneumophila serogroup 1 and that same antigen can also be detected in patients with non-pneumonic illness. CULTURE Culture is primarily used when a clinical case is suspected. The isolated strains need further analysis such as strain typing or Maldi-ToF Mass Spectrometry for identification. The culture method itself is very sensitive and has high specificity, however these cultures require long incubation times. IMMUNOFLUORESCENCE When using immunofluorescence two methods can be used, indirect or direct. Both methods can give false positives due to cross-reactivity between different Legionella pneumophila species. Since sero conversion occurs within two weeks, the indirect method can delay the diagnosis. Direct method (DFA) is used to rule in legionellosis and not to rule out due to low sensitivity. PCR Polymerase Chain Reaction methods can be used directly on respiratory specimens and is therefore useful in a respiratory panel testing, syndromic approach, or in a situation as described in the algorithm where a urine test turns negative but high suspicion remains. It is a rapid method and limitations are mainly linked to the assay. MALDI-TOF MASS SPECTROMETRY Successful use of Mass Spectrometry has been done in conjunction with culture, fresh from plate and the technique can be used both on clinical and environmental isolates. Given the different methods available, all of them come with pros and cons and to have an efficient diagnosis, a combination of techniques should be used most often. THE DETECTION OF LEGIONELLA IN WATER SAMPLES Domestic water systems are frequently tested for Legionella to control contamination. European regulations state that Legionella must be absent in water from high-risk healthcare establishments. For other types of water, the target level should not exceed 100 cfu/liter. Alert levels and action levels, for example for disinfection, are defined according to the water type. Legionella detection and enumeration in water samples are done by cultivation of filtered samples on GVPC media, or MWY media for highly contaminated waters, for 10 days. The presumptive Legionella colonies are then confirmed by demonstrating their growth requirement for L-cystein and iron. FOR MORE INFORMATION Please contact your biomérieux representative for more information on the biomérieux Legionella solutions. 13

14 Prostate Specific Antigen (PSA) tested with VIDAS 3 at Prostataklinikken in Oslo The 25 th of September 2014 was the official opening of the Prostate Clinic in Oslo. The clinic is the first diagnostic center for prostate cancer in Scandinavia that uses the ANNAcTRUS method for diagnosis of prostate cancer. The opening ceremony was visited by Schleswig-Holsteins Health minister Kristin Alheit, Mayor of Oslo city, Fabian Stang and Prof., MD. Per Anders Abrahamsson, General Secretary of the European Association of Urology (EAU). The Prostate Clinic is located in the center of the city of Oslo, in Majorstuen. The clinic offers investigation and specialist treatment in the field of urology with the focus on male health. All investigations are performed by a competent team of an urologist, a doctor and a nurse. They follow the patient before, during and after examination. The patient should feel safe with us and we prioritize clear communication and good follow up says Dr. Jalil Davami. We had the pleasure to meet Veronika Katrin Andreassen, nurse and clinic manager. During a tour of the clinic we asked about their activities. 14

15 Firstly, can you simply explain to the readers what prostate cancer is? Prostate cancer is the most common type of cancer in men. In Norway around 5,000 men are diagnosed with cancer in the prostate gland every year. In many cases, prostate cancer doesn t show any symptoms. When symptoms occur, they are usually divided into two main types. The first type is the same as can be seen in BHP (prostatic hyperplasia) and prostatitis, which is urination problems, impotence and blood in the urine. Other main symptoms are caused by the spread (metastases) of the prostate cancer to the skeleton or other organs in the body. This is shown as pain in the pelvis and lower back. How can this method help in the fight against prostate cancer? ANNAcTRUS was developed in USA and Germany, and already thousands of patients have been helped by this method. Where traditional methods have not been able to detect prostate cancer, the ANNAcTRUS method has. Early detection is essential for the healing process. You have chosen to analyze Prostate Specific Antigen (PSA) in your clinic on the VIDAS 3 immunoanalyzer, to recieve an answer the same day. Why is that important for you? At our clinic, we have chosen to offer our patients answers on the same day because we know that waiting for those answers can cause great stress. When a man has taken the first step to come here and measure his PSA-value, it is therefore a great pleasure to be able to offer that service. What is it that you like about your VIDAS 3 analyzer? VIDAS 3 has simplified our laboratory work considerably. The machine is impressively smart and it tells us if something is wrong and how the problem should be solved. It minimizes human error and provides security and traceability. It is safe and accurate! You feel confident with the system and the results. What do your key messages Pioneering technology accurate diagnoses - regular follow up mean to you? Thanks to our technology, we can offer the patient a gentle investigation and at the same time give an accurate diagnosis. This is of great importance to us. Our experience is that, in general, the follow up is deficient, and therefore we focus very much on this at our clinic. We follow up on different levels and areas so that the patient feels respected and safe. What is ANNAcTRUS? ANNAcTRUS was developed by urologists, for urologists, with the main objective to carry out targeted primary biopsies. The method is based on a comprehensive database of analyzed cases of illness. Through comparison of the patient s ultrasound images with this database, especially suspicious areas in the prostate gland can be identified and marked on the ultrasound image. First, the urologist takes images of the prostate gland and transfers them to the ANNAcTRUS database. There, the suspicious sites are identified and marked with colored dots that give the urologist information about which parts of the prostate gland have harmfully changed tissue. By using ANNAcTRUS, the number of tissue samples collected can be reduced by half, because the urologist knows which areas of the prostate gland they should take samples from. And finally, what do you recommend for a person who is worried about prostate cancer? Take a PSA blood test! The level of PSA in the blood increases in most cases of prostate cancer. You can also see increased levels in benign hyperplasi (enlarged prostate gland) and in inflammation in the gland and/or urinary tract. An increased PSA level is only an indication of an incident in the prostate gland, but it is a very good starting point for further investigations. Remember, early detection is essential for good recovery! AUTHOR: Teresa Gunnarsson Clinical Product Manager teresa.gunnarsson@biomerieux.com 15

16 Bacillus cereus An unwelcome guest in our food Bacillus cereus is a common cause of food-borne illness worldwide. Even though B. cereus caused illness is estimated to be vastly underreported, up to 5% of the food-borne illness that is reported, it is caused by this microorganism. B. cereus can cause two different types of food-borne illnesses. The diarrheal type is caused by enterotoxins produced during B. cereus growth in the intestines. The emetic type that causes vomiting and abdominal pain is caused by a different toxin, produced by the organism growing in food that is later consumed. In most cases the patient recovers within six to twenty-four hours, but the toxins can be fatal, especially to infants. B. cereus can also cause other infections such as sepsis and eye and skin infections, but that is relatively uncommon and mostly associated with compromised patients. One reason why B. cereus is such a common food pathogen is that it is spore forming. This means that heating of the food does not kill the bacteria, as with most other microorganism, but instead causes spore germination and excellent growth conditions. The growth temperature of the organism can vary between 4 C and 55 C, which makes it even more prone to growth in food. In addition, the toxin produced by the organism growing in food is heat resistant, and will not always be destroyed by cooking. THE B. CEREUS GROUP The B. cereus specie is one of a group of organisms so closely related that they are very difficult to distinguish. The Bacillus cereus group includes B. anthracis, B. cereus, B. thuringiensis, B. mycoïdes, B. pseudomycoïdes and B. weihenstephanensis. Most other organisms in the group do not normally cause food poisoning, with the exception of B. anthracis, which is highly pathogenic not only in food. REGULATION OF B. CEREUS TESTING The testing for B. cereus in dried infant formula is well regulated in both the EU and US, but since the bacteria is soil-dwelling and can easily be spread, other food products such as vegetables, fruit, cereals and ready to eat food are also tested. In food poison outbreak investigations, for surveillance and when there is suspicion of high concentration in specific food products, the B. cereus is frequently tested. In outbreaks of B. cereus, the concentration of the bacteria in the food has been found to be more than 10 5 cfu/g. 16

17 According to the Swedish National Food Agency, food should be considered as unsatisfactory at concentrations greater 4 than 10 cfu/g. The food poisoning effects of B. cereus were first documented and published after an outbreak in Oslo due to contaminated vanilla sauce. The Norwegian professor, Steinar Hauge, cultivated the bacteria from the vanilla sauce to 6 10 organisms/ml and drank 200 ml of the culture. 13 hours later he developed abdominal pain and diarrhea. The diagnosis of B. cereus in patients is mostly limited to symptoms and epidemiological investigations. There are several different ways to test B. cereus in food, either on agar plates or with automated methods. None of the methods available will distinguish between the 6 species in the group, since they are so closely related. When it comes to food quality it is the B. cereus and B. antraxis that are of interest, but positive results for B. thuringiensis also appear in the laboratories from time to time. THE USE OF B. THURINGIENCIS AS PECTICIDE Bacillus thuringiensis is mainly toxic to insects and usually not to humans, and is commonly used as a biological pesticide. This characteristic of B. thuringiensis was discovered in 1911, and it has been used as an insecticide since the 1920 s. It is usually sprayed on the crop as a suspension of spores or bacterial proteins. The B. thuringiensis genes have also been used to genetically modify potato, corn and soybean plants to become insect tolerant. Crops treated with B. thuringiensis spores, such as corn, tomato, rice and soybeans, can cause positive results in the food laboratory testing for B. cereus. When it happens, the organism must be isolated and identified to exclude the risk of food poisoning. FOOD TESTING METHODS In the reference method for B. cereus enumeration in food, ISO 7932:2004, the sample is incubated on Mannitol egg Yolk Polimixin (MYP) agar for hours. The B. cereus grows in pink colonies with a halo. The colonies need to be confirmed by hemolysis reaction on TSA Sheep blood agar. In the NMKL method No 67 the sample is incubated on TSA blood agar for hours, where the B. cereus grows in grey/ white colonies surrounded by a hemolytic zone. The confirmation is done on B. cereus selective agar or Cereus-Ident-AGAR. In the alternative BACARA method, the sample is incubated on BACARA agar for 24 hours. The B. cereus colonies are distinctive orange/pink with a halo, and no confirmation is needed. TEMPO is an automated alternative method for enumeration of B. cereus and other quality indicators in food samples. The food sample is automatically incubated and read in the tempo cards, where detection is done with enzymatic fluorescence. Incubation time is hours, the result is given as a cfu/g sample, and no confirmation is needed. A lot of things will impact a decision in the laboratory on which method to use for the B. cereus detection. What kind of food will be tested, how many samples are tested every day, how many of those are expected to be positive, what kind of background flora you have in the samples as well as the sensitivity and specificity requirements, the demands for short lead times to results, the workflow in the lab and the price of the tests. AUTHOR: Charmain Kanstrup Food Account Manager charmain.kanstrup@biomerieux.com Stämmer webbadressen? References: Tallent, S.M. et al, Efficient isolation and identification of Bacillus cereus group. Journal of AOAC International. J AOAC Int Mar- Apr;95(2): Granum, P.E., Bacillus cereus, p In Doyle, M.P., Beuchat, L.R. (ed.), Food Microbiology Fundamentals and Frontiers, 3 rd Ed. ASM Press, Washington, D.C. Forbes, B.A. et al, Bailey & Scott s Diagnostic Microbiology, p , Mosby, Inc., St. Louis. 17

18 ECCMID 25th European Congress of Clinical Microbiology and Infectious Diseases April 25 th 28 th 2015, Bella Center in Copenhagen, Denmark This year the European Congress of Clinical Microbiology and Infectious Diseases was held in Denmark, at the Bella Center outside Copenhagen. biomérieux presented new methods and technologies in a booth, and also organized an integrated symposium under the theme Molecular Diagnostics: Today and Tomorrow. The symposium featured discussions about molecular methods for the diagnosis of respiratory tract infections, syndromic approaches for diagnosis, typing by sequencing and the next generation sequencing in microbiology laboratories. TEXT AND PHOTO: Teresa Gunnarsson Clinical Product Manager teresa.gunnarsson@biomerieux.com 18

19 BIOMÉRIEUX NORDIC Your contact information For technical and application support Please contact our Customer Service Team Or Phone: Denmark Finland Norway Sweden Your Expert in Infectious Diseases, Together Moving Forward For orders Please send your orders to the following addresses: Denmark... Finland... Norway... Sweden... Questions on orders, deliveries and invoices Please contact our Sales Administration team Contact our biomérieux offices: Denmark Finland Norway Sweden

20 2015 Exhibition participation biomérieux Nordic Training offer 2015 LABINNOVATION September 23 24, Kistamässan Stockholm, Sweden NMMD NETWORK MEETING MOLECULAR MICROBIAL DIAGNOSTICS October 8 9, Karolinska Stockholm, Sweden LABT LABORATORY MEDICINE AND EXHIBITION October 8 9, Marina Congress Center Helsinki, Finland HØSTKONFERANSEN I MIKROBIOLOGI 2015 October 15 16, Scandic Nidelven Trondheim, Norway DMS DANISH MICROBIOLOGICAL SOCIETY CONGRESS November 9, Eigtveds Pakhus Copenhagen, Denmark TEMA RENRUM November 17 18, Scandic Infra City Upplands Väsby, Sweden BACT/ALERT ADVANCED Oct. 7 8 VITEK AES - WEBEX Oct. 14 SARAMISTM DATABASE BUILDING Nov FOR MORE INFORMATION: Sara Williamson Customer Service Manager sara.williamson@biomerieux.com / This document is not legally binding. biomérieux reserves the right to make changes without notice / biomérieux, the blue logo, BacT / ALERT, BioNexia, LABGUARD, Etest, ChromID, VITEK, VITEK 2, VITEK MS, PREVI Isola, Myla are used, pending and / or registered trademarks of biomérieux SA or one of its subsidiaries. Other names or trademarks property of their respective owners. / Printed in Sweden / Design and layout: In Time Reklambyrå HEAD OFFICE biomérieux Sweden AB Hantverksvägen 15 SE Askim Sweden Phone: contact.nordic@biomerieux.com biomérieux Denmark ApS Tel: biomérieux Norge AS Tlf: biomérieux Suomi Oy Puh: