TECHNICAL NOTENo. 6 DECEMBER Authors: - Olivier MOLINIER - Mylène MARECHAL

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Improving together TECHNICAL NOTENo. 6 PRECISION MODELS IN BASIC MICROBIOLOGY, PSEUDOMONAS AERUGINOSA AND PATHOGENIC STAPHYLOCOCCI IN CLEAN WATERS OUTCOMES ON THE UNCERTAINTIES OF MEASUREMENTE This document is based on the results and observations of A.G.L.A.E. s proficiency tests DECEMBER 215 Authors: - Olivier MOLINIER - Mylène MARECHAL AGLAE Association Parc des Pyramides 427 rue des Bourreliers 5932 Hallennes lez Haubourdin France +33 ()3 2 16 91 4 contact@association aglae.fr www.association aglae.fr Page 1/16

ABSTRACT In this technical note, A.G.L.A.E. communicates almost 15 years of experience to help you understand and interpret precision models in basic microbiology and for some pathogens in clean. For the parameters considered, the evolution of the reproducibility depending on the bacterial load level is presented in order to statistically comprehend the variability of bacterial enumeration during routine analysis. The direct links with the uncertainty of measurement calculations at the profession scale and the perspectives in terms of calculation tools are also discussed at the end of the document. Page 2/16

CONTENTS 1. INTRODUCTION... 4 2. DATA... 4 3. METHODS... 4 4. RESULTS AND DISCUSSION... 5 5. OUTCOMES ON THE UNCERTAINTIES OF MEASUREMENT OF THE PROFESSION... 12 6. PERSPECTIVES... 15 7. DESIGN AND ET DEVELOPMENT OF THE TECHNICAL NOTE... 15 8. BIBLIOGRAPHY... 16 Page 3/16

1. INTRODUCTION In parallel to the first objective of proficiency testing which is to answer the question: are the analyses results of my laboratory satisfactory?, two other questions and not the least are raised during the conduct of each proficiency test: - What is the bacterial load level of the test materials? - What is the dispersion (distribution of results) around this bacterial load level observed by the profession? The statistical processing of participants results enables us to address these three questions for each proficiency test. For each analytical parameter, a transversal study of data obtained for a large number of tests allows to provide an estimate of the interlaboratory dispersion at any level of the quantification range. 2. DATA This study was carried out with data from proficiency tests conducted from 22 in the frame of programme 3 Microbiology in clean and of programme 31 Pseudomonas aeruginosa and pathogenic staphylococci in clean. Depending on the parameters, the data of 23 to 42 proficiency tests were processed to produce the precision models. The matrices used to prepare the test samples were chlorinated and neutralized drinking or only neutralized for some tests. For most parameters, spiking had been carried out with strains grown in broth. The methods used by the participants for the detection and enumeration of germs mainly corresponded to French standards in use in the frame of sanitary control. 3. METHODS 3 1 Statistical processing of proficiency testing results The means and reproducibility standard deviation were evaluated from the results of participants who had analysed during the recommended period to start the sample analysis. This enabled us not to include possible instabilities during the calculation of these statistics. These values were calculated following the guidelines of ISO 13528, ISO 5725 1 and ISO 5725 2 standards with the use of tests detecting outliers. Except for the very low counts, the log normal distribution is commonly used to fit bacterial enumerations counts (ISO 22117, 21). Page 4/16

3 2 Development of reproducibility models Evolution models of the reproducibility depending on the bacterial load levels were produced for each parameter. As a first step, this modelling consisted in selecting the best mathematical fitting of the reproducibility standard deviations scatter plots s R depending on the means m expressed in a log scale following the guidelines of the ISO 5725 2 standard. Secondly, a chart of the squatter plots and the selected models was carried out keeping the coefficient of variation CVR% for the y axis and the mean m for the x axis, with: - CVR% = R / m 1 On the same chart and in the same calculation scale, the curve corresponding to the intrinsic variability of any microbial count, modelled by the Poisson distribution, was also displayed. 4. RESULTS AND DISCUSSION Results per parameter: 7 6 Coliform Bactéries bacteria coliformes Figure 1: chart of the reproducibility coefficient (CVR) in % depending on the mean number of CFU in log for the parameter «coliform bacteria» (ISO 938 1 ()) CVR% 5 4 3 2 1,5 1 1,5 2 2,5 3 Mean Nombre number moyen of d'ufc CFU per par test prise portion d'essai (log) (log) Caption: - Coloured points: interlaboratory comparisons conducted between 22 and 215 - Red curve: evolution model - Black curve as a full line and dotted line: curve corresponding to the Poisson distribution Page 5/16

Figure 2: chart of the reproducibility coefficient (CVR) in % depending on the mean number of CFU in log for the parameter «Escherichia coli» (ISO 938 1 ()) 7 6 5 4 CVR% 3 E. coli 2 1,5 1 1,5 2 2,5 3 Mean Nombre number moyen of CFU d'ufc per par test prise portion d'essai (log) (log) 7 6 Culturable germes micro organisms revivifiables at 22 C à 22 C Figure 3: chart of the reproducibility coefficient (CVR) in % depending on the mean number of CFU in log for the parameter «Culturable microorganisms at 22 C» (ISO 6222 (99)) CVR% 5 4 3 2 1,5 1 1,5 2 2,5 3 Nombre moyen d'ufc par prise d'essai (log) Mean number of CFU per test portion (log) Caption: - Coloured points: interlaboratory comparisons conducted between 22 and 215 - Red curve: evolution model - Black curve as a full line and dotted line: curve corresponding to the Poisson distribution Page 6/16

7 Figure 4: chart of the reproducibility coefficient (CVR) in % depending on the mean number of CFU in log for the parameter «Culturable microorganisms at 36 C» (ISO 6222 (99)) CVR% 6 5 4 3 Culturable germes micro organisms revivifiables at à 36 C 36 C 2 1,5 1 1,5 2 2,5 3 Nombre moyen d'ufc par prise d'essai (log) Mean number of CFU per test portion (log) 7 6 Intestinal enterococci entérocoques intestinaux Figure 5: chart of the reproducibility coefficient (CVR) in % depending on the mean number of CFU in log for the parameter «Intestinal enterococci» (ISO 7899 2 ()) 5 4 CVR% 3 2 1,5 1 1,5 2 2,5 3 Mean Nombre number moyen of CFU d'ufc per par test prise portion d'essai (log) (log) Caption: - Coloured points: interlaboratory comparisons conducted between 22 and 215 - Red curve: evolution model - Black curve as a full line and dotted line: curve corresponding to the Poisson distribution Page 7/16

7 6 spores de germes anaérobies Spores of sulfite reducing anaerobes sulfito-réducteurs 5 Figure 6: chart of the reproducibility coefficient (CVR) in % depending on the mean number of CFU in log for the parameter «Spores of sulfite reducing anaerobes» (NF EN 26461 2 (93)) 4 CVR% 3 2 1,5 1 1,5 2 2,5 3 Mean Nombre number moyen of d'ufc CFU per par test prise portion d'essai (log) (log) 7 6 Pseudomonas aeruginosa Figure 7: chart of the reproducibility coefficient (CVR) in % depending on the mean number of CFU in log for the parameter «Pseudomonas aeruginosa» (ISO 16266 (8)) 5 4 CVR% 3 2 1,5 1 1,5 2 2,5 3 Nombre moyen d'ufc par prise d'essai (log) Mean number of CFU per test portion (log) Caption: - Coloured points: interlaboratory comparisons conducted between 22 and 215 - Red curve: evolution model - Black curve as a full line and dotted line: curve corresponding to the Poisson distribution Page 8/16

Figure 8: chart of the reproducibility coefficient (CVR) in % depending on the mean number of CFU in log for the parameter «pathogenic staphylococci (coagulase positive)» (XP T 9 412 (6)) 7 6 5 4 CVR% 3 2 pathogenic staphylocoques staphylococci pathogènes (coagulase (coagulase positive) +) 1,5 1 1,5 2 2,5 3 Mean Nombre number moyen of d'ufc CFU per par test prise portion d'essai (log) (log) Caption: - Coloured points: interlaboratory comparisons conducted between 22 and 215 - Red curve: evolution model - Black curve as a full line and dotted line: curve corresponding to the Poisson distribution For each parameter, the scale illustrates the maximal dispersion (coefficient of variation in reproducibility) that the profession should expect for any level of the working range. For example, at a mean load of 3 germs per test portion (so around 1,5 in log), the variability observed in log is: 6% for the enumeration of the intestinal enterococci 8% for the enumeration of the pathogenic staphylococci 14% for the enumeration of the spores of sulfite reducing anaerobes Note: these notions of mean and in particular of variation in log can be felt as not intuitive for the microbiologists of the environment. This is the reason why for the uncertainty calculations, a change of scale is usually done in order to allow a reasoning in the natural scale of enumerations (in CFU per test portion refer to section 5). Page 9/16

The curve representing the Poisson distribution (in black) enables us to visualise the ideal case where only the random variability due to the distribution of the germs in the sample is observed during the interlaboratory tests. This curve is the one which can be kept to characterize the dispersion obtained in the most homogeneous conditions of the analysis that are the repeatability conditions, this for all the parameters covered in the frame of this study. It can be noticed that for the intestinal enterococci and E. coli, the evolution model (red curve) is very close, almost overlaid, to the Poisson distribution. This means that the results from one laboratory to another (in reproducibility conditions) are almost totally explained by the random variability (very close to the results in repeatability). This is the ideal case where the implementation of the standardised method in different laboratories does not produce technical disparities that can impact the results. From a microbiological point of view, for the intestinal enterococci, the good selectivity of the Slanetz and Bartley medium coupled with the total confirmation of presumptive colonies by membrane transfer onto BEA medium can explain the good performances of the method. The enumeration of E. coli has the advantage to rest upon the detection of a germ clearly defined from a taxonomic point of view. Despite of the partial confirmation by "random" picking of the presumptive colonies (oxidase and indole), the results present also a good reproducibility. On the opposite, the "culturable micro organisms at 22 C and at 36 C" are among those presenting the highest reproducibilities. From a technical point of view, the enumeration of the total flora according to ISO 6222 is a method that can lead to disparities due to the sensitivity of the strains or of the natural population with regard to the temperature of the poured medium and of the physiological state of the germs facing the thermal shock. It can be noted the inoculation volume of 1 ml is reduced compared to the other parameters of this study. The variability inherent in the incubation conditions (as described in the ISO 2921), could be a component contributing to a dispersion of interlaboratory results, considering the use of a non selective medium. The enumeration of the spores of sulfite reducing anaerobes is the other parameter leading to large interlaboratory disparities. The multiplicity of analytical modalities (in particular thermal treatment, membrane porosity and anaerobiosis) and the issues regarding the robustness of the ISO 26461 2 methodology, several times highlighted in our test reports, are critical factors leading to this observation. At an "intermediate" level of interlaboratory dispersion, there is the enumeration of coliform bacteria which, as "group of bacteria", logically presents more variability than E. coli on its own, as well as the two pathogens covered by the study. For Pseudomonas aeruginosa, it can be noticed that, from our observations, the type of characteristic colonies (as defined in ISO 16266) does not impact the reproducibility observed. Despite of the required acetamide confirmation step, no larger interlaboratory variability is observed when the strains introduced produce non bluegreen colonies but fluorescent ones (yellow data points on Figure 7) In comparison with tests for which the colonies produce a blue green pigmentation (green data points on Figure 7). For each of the two types of characteristic colonies, non target strains had sometimes been introduced for some tests (Ps. putida, Ps. mendocina, Serratia rubidaea ). For the pathogenic staphylococci (coagulase positive), it can be noted that the tests where major differences between the types of culture medium (Chapman BP BP+RPF) had been detected are not presented among the data points displayed, which tends to idealise the evolution model obtained. Nevertheless, the revision of the standardisation of the method XP T 9 412 to come with the use of only one type of culture medium (BP+RPF) should theoretically lead to the observation of an improved reproducibility. Page 1/16

This hypothesis rests, between others, on a study related to the results variability according to the type of culture medium observed and on an examination of the effects «culture medium manufacturer» and «membranes manufacturer» within each type of medium. In order to determine a possible effect due to the strain, the last 32 AGLAE s interlaboratory tests for which test samples had been spiked with one strain only, were transversally processed. A summary of the differences between types of culture medium is presented below in figure 9 for each of the 8 strains tested for these tests. Observation of a lower distribution for CHAPMAN medium Observation of a higher distribution for CHAPMAN medium Observation of a higher distribution for BP medium Observation of a lower distribution for BP+RPF medium No difference between the different types of medium Figure 9: pie charts of significant differences between types of culture medium for the parameter «pathogenic staphylococci (coagulase positive)» It is important to keep in mind that among the 8 strains tested, 6 of them showed significant differences detected on CHAPMAN medium (in comparison with BP and BP+RPF) whereas 2 of them showed differences on BP + RPF medium (in comparison with Chapman and BP). On the other hand, significant differences, of greater or lesser extent, between «culture medium manufacturer» and «membranes manufacturer» were also detected within CHAPMAN and BP + RPF medium. Table 1 here after illustrates this information. Page 11/16

Strains Observations Differences between «medium manufacturer» CHAPMAN Differences between «medium manufacturer» BP+RPF Differences between «membrane manufacturer» associated with CHAPMAN medium Differences between «membrane manufacturer» associated with BP+RPF medium strain 1 strain 2 strain 3 strain 4 strain 5 strain 6 strain 7 strain 8 8% 25% 25% % % % 1% 67% 4% 5% 25% 33% % % % % 8% 75% 5% 1% % 33% 5% % % 25% 25% % % % % % Table 1: Review of the number of tests where a difference was detected (in %) depending on the strain used and the type of culture medium used for the parameter «pathogenic staphylococci (coagulase positive)» Note: for a given test, it is possible that a difference is detected for several types of medium Through proficiency testing, BP+RPF medium seems to produce less differences between consumables manufacturers, in comparison with CHAPMAN medium; which should theoretically reduce the disparities from one laboratory to another one if the standardisation selects exclusively the first medium. 5. OUTCOMES ON THE UNCERTAINTIES OF MEASUREMENT OF THE PROFESSION The ultimate objective which is generally aimed during a transversal study of interlaboratory comparisons is the connection between the precision observed and the determinations of the uncertainties of measurement. As a reminder, the uncertainty of microbiological methods consists of two components (ISO 2921, 212): - the intrinsic variability (distribution uncertainty) associated with the random distribution of germs in the sample. From a statistical point of view, it is modelled by the Poisson distribution, - the operational variability (technical uncertainty) which is the combination of all the uncertainties associated with the technical steps of the analytical protocol. This is the component to evaluate. For each chart presented in section 4, the difference between the black curve (Poisson distribution) and the red curve (evolution model) represents the operational variability (technical uncertainty) observed by the profession and expressed in a log scale. Page 12/16

Yet, the metric used to describe the uncertainty of measurement in microbiology is the relative variance, u², calculated from the number of counted colonies. From a mathematical point of view, the parameter u² comes from a particular expression of the variance according to the Negative Binomial distribution and represents the over dispersion in relation to the Poisson distribution (ISO 13843, 2). From a biostatistical point of view, this over dispersion corresponds to the operational variability then qualified as "relative" that we are interested in evaluating. The use of this metric allows to reason in the natural scale of the number of bacteria per test portion. In concrete terms, to transform the variances in log to the relative variances in u², a conversion can be applied following the ISO 2921 guidelines: - u tr ² = 5,319 s R ² with u tr ² = relative standard uncertainty of interlaboratory reproducibility s R ² = relative standard uncertainty of interlaboratory reproducibility, expressed in log An ultimate calculation step allows to deduce the relative operational variance and designated as u R ²: - u R ² = u tr ² u Poisson ² with u R ² = relative operational variance of interlaboratory reproducibility (technical uncertainty in reproducibility) u Poisson ² = intrinsic relative variance (uncertainty of Poisson distribution) Thus, for each parameter considered and for each test, the application of these conversions allows to transform the interlaboratory variability measured in uncertainty of measurement for the profession. For example, for the enumeration of coliform bacteria, parameter for which we could highlight the extent of the reproducibility in the previous chapter, the expression of the interlaboratory variability in u R ² is visualised on Figure 1 below.,2 Coliform Bactéries bacteria coliformes Figure 1: chart of the squared standard deviation of the profession, u R ², depending on the mean obtained for each test for the parameter "coliform bacteria" u R ²,15,1,5 u R ² =,289,5 1 1,5 2 2,5 3,5 Nombre Mean number moyen of CFU d'ufc per test par portion prise (log) d'essai (log) Caption: - Green data points: u R ² for the different proficiency tests conducted - Red dotted line : mean value of u R ² Page 13/16

This type of information related to the uncertainty of measurement of the profession is provided in our test reports for the programmes 3 (basic microbiology) and 31 (Pseudomonas aeruginosa and pathogenic staphylococci). For a global estimate of the uncertainty, the operational variance is specified depending on the conditions in which the measurements were obtained. It is the general information about the profession from the FD T 9 465 1: - u r ² for the repeatability conditions - u R ² for the interlaboratory reproducibility conditions Table 2 below summarises all the estimates updated for the parameters studied in this technical note. Parameters u r ²: repeatability conditions u R ²: interlaboratory reproducibility conditions Coliform bacteria,,289 Escherichia coli,,68 Culturable micro organisms at 22 C,,1542 Culturable micro organisms at 36 C,,1649 Intestinal enterococci,,64 Spores of sulfite reducing anaerobes,,1725 Pseudomonas aeruginosa,,141 Pathogenic staphylococci,,541 Table 2: Summary of the uncertainty estimates for the profession (values available in October 215) Note that the u R ² value for each parameter is the mean of available estimates for all the proficiency tests already carried out (ex : u R ² =,289 in figure 1 and of table 2 above). Regarding the mean value of u r ², it is not significantly different from, for a large number of proficiency tests. This is the reason why the null value was kept. These values of u² can be transformed in concrete information about the uncertainty, as recommended by the document FD T9 465 1: limit of detection (LD), confidence interval (or of credibility) confidence interval around a result observed For example: for the enumeration of coliform bacteria in 1 ml, with u R ² =,289 LD = 3,13 germs in 1 ml For 6 confirmed colonies observed on a Petri dish: o result = 6 coliform bacteria in 1 ml o Confidence interval: between 2,16 and 13,68 coliform bacteria in 1 ml, at the risk of 5% The conversion modalities of u² in explicit information about the uncertainty are described in the document FD T9 465 2. Page 14/16

For information only, an empirical scale of the technical uncertainties that can be observed during routine tests is presented in figure 11 here after in. At the scale of the profession or at any laboratory s level, this scale can enable us to apprehend and to put into perspective the extent of any uncertainty evaluated in terms of u², with regard to the experience acquired in the water microbiology field. u²:,,2,1,2,25,4 u%: %... 14%... 32%... 45%... 5%... 63%... Loi Poisson de Poisson disribution Incertitude Low faible uncertainty Tangible Incertitude uncertainty tangible High Incertitude uncertainty élevée Figure 1: empirical scale of the uncertainty of measurement in water microbiology Note : Poisson distribution: intrinsic variability (entirely random distribution uncertainty of the particles during the sampling of a perfectly homogenised suspension) "Technical" uncertainty: operational variability corresponding to the over dispersion with regard to the Poisson distribution, in terms of relative variance (u²) or relative standard deviation (u% = squared root (u²) 1) 6. PERSPECTIVES Perspectives can be seen in terms of modelling of the microbiological measurements variability, so that the models routinely used to process proficiency testing results rest directly on random variables known as the most appropriate from a biostatistical point of view (Poisson distribution, Negative Binomial or Gamma Poisson). These improvements could in particular allow to avoid the transformation of counting data which could disturb the dispersion estimates and would provide the opportunity of a total connection between the statistical indicators used for the uncertainty of measurements calculations and the ones used for the analytical performance assessment in the frame of the External Quality Control. 7. DESIGN AND ET DEVELOPMENT OF THE TECHNICAL NOTE The present technical note was carried out by the Biology data processing team, in collaboration with the technical team and AGLAE s management and published after consulting the Microbiology Technical Committee. We sincerely thank the members of the Technical Committee for their acute reading. Page 15/16

8. BIBLIOGRAPHY FD T9 465 1: 214 Water Quality Protocol for the estimation of the uncertainty of measurement associated with an analysis result for microbiological enumeration methods Part 1: References, definition and general principles FD T9 465 2: finalisation on going Water Quality Protocol for the estimation of the uncertainty of measurement associated with an analysis result for microbiological enumeration methods Part 2: case of enumeration methods ISO 13528:215 Statistical methods for use in proficiency testing by interlaboratory comparison ISO/TR 13843:2 Water quality Guidance on validation of microbiological methods ISO/TS 22117:21 Microbiology of food and animal feeding stuffs Specific requirements and guidance for proficiency testing by interlaboratory comparison ISO 2921:212 Water quality The variability of test results and the uncertainty of measurement of microbiological enumeration methods ISO 5725 1:1994 Accuracy (trueness and precision) of measurement methods and results Part 1: General principles and definitions ISO 5725 2:1994 Accuracy (trueness and precision) of measurement methods and results Part 2: Basic method for the determination of repeatability and reproducibility of a standard measurement method ISO 16266:28 Water quality Detection and enumeration of Pseudomonas aeruginosa Method by membrane filtration ISO 6461 2:1993 Water quality Detection and enumeration of the spores of sulfite reducing anaerobes (clostridia) Part 2: Method by membrane filtration ISO 6222:1999 Water quality Enumeration of culturable micro organisms Colony count by inoculation in a nutrient agar culture medium ISO 7899 2:2 Water quality Detection and enumeration of intestinal enterococci Part 2: Membrane filtration method ISO 938 1:2 Water quality Detection and enumeration of Escherichia coli and coliform bacteria Part 1: Membrane filtration method XP T 9 412:26 Water quality Detection and enumeration of pathogenic staphylococci Membrane filtration method Page 16/16