Applied and Environmental Microbiology, September 2008, p. 5599-5607, Vol. 74, No. 18
0099-2240/08/$08.00+0 doi:10.1128/AEM.00966-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.
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Federal Bureau of Investigation Laboratory, Quantico, Virginia,1 UMDNJ-New Jersey Medical School, Newark, New Jersey 07103,2 Centers for Disease Control and Prevention, Atlanta, Georgia,3 Centers for Disease Control and Prevention, Cincinnati, Ohio,4 University of Cincinnati, Cincinnati, Ohio,5 Los Alamos National Laboratory, Los Alamos, New Mexico,6 California Department of Public Health, Richmond, California,7 Virginia Polytechnic Institute and State University, Alexandria, Virginia,8 Lawrence Livermore National Laboratory, Livermore, California,9 University of North Texas Health Science Center, Fort Worth, Texas,10 Office of the District Attorney, Alameda County, Oakland, California,11
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TABLE 1. Elements of validation guidelines for methods and procedures for analyses
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A developed and implemented standard operating protocol or procedure (SOP) readily available for all scenarios is not likely. There is a large variety of possible biocrime and bioterrorism scenarios for which a previously validated method may not always be available. Exigency may demand a tool or method (for collection, extraction, or analysis) that has not been validated previously. Clearly, it is irresponsible to wait for months or years for the validation of a procedure when an attack is under way and safety or security is imminently threatened. Therefore, it can be anticipated that some methods of generating investigative leads may not have been through as extensive a validation process as might be carried out when attention is paid to developmental and internal-validation requirements. Consider the scenario where an innocuous bacterial species has been used in an attack and it has been engineered such that it is highly virulent in humans. Because of the lack of interest in the particular species prior to the attack, there might be no fully validated strain identification method for this species in public health or forensic laboratories. A research laboratory protocol might be sought because of the imminent need to respond. However, even in this case, quality assurance and control considerations and understanding the limitations of a method should not be overlooked. In this context, preliminary validation is an early evaluation of a method that will be used to investigate a biocrime or bioterrorism event. A preliminary validation should be carried out to acquire limited test data to enable the evaluation of a method for its investigative-lead value, with the intent of identifying key parameters and operating conditions and of establishing a degree of confidence in the methods of collection, extraction, and analysis. The evaluation may be based on peer review of existing data by a panel of experts that makes recommendations for additional evaluations, studies that may be needed prior to the processing of evidentiary material, or studies that may be carried out after certain results are obtained. The goal is to be able to respond to a biocrime expeditiously, effectively, and efficiently while maintaining scientifically valid and legally defensible approaches. Preliminary validation is expected to be a normal occurrence in those situations where methods have not been through external and internal validation but are deemed necessary to support an investigation (criteria for preliminary validation are under development).
As stressed above, often the basic concept of validation is appreciated; yet the criteria for validation are seldom consistently defined or described and applied. It is common for the term validation to be used vaguely or to remain undefined when applied to a process performance evaluation. The degree of validation varies from nominal to rigorous. The consequences of such varied requirements can be catastrophic if methods used in microbial forensic investigations are poorly constructed, are underdeveloped, and/or generate results that are difficult to interpret. To avoid these shortcomings, it is necessary to develop a set of validation criteria and a validation plan so that procedures are subjected to rigorous evaluation at an acceptable level of quality based on the context in which the procedures may be applied.
Even though it is not possible to provide a specific validation template for the innumerable methods that could assist in a microbial forensic investigation, a checklist of parameters may establish minimal acceptable validation criteria. A researcher and developer can review the checklist and determine which criteria apply and also provide legitimate justification for why some criteria are not applicable. Those who rely on the use of the tool or results obtained will be able to assess the performance in proper context based on the validation criteria used. Those who validate a system should document the tested parameters so that they may be reviewed and assessed by interested parties. The following recommendations should provide a basis within the microbial forensics community for validating methods and processes and for fostering discussion and input for developing the best validation practices as they evolve or for validating new methods as they are developed. Since the process of validation attempts to define the limitations and test the fundamental assumptions of the method being evaluated, the experimental validation design should accumulate performance data on each of the method parameters to enable proper inferences based on the results of the analysis. Thus, a validation plan should define the range of conditions under which the process may be applied so that (i) the interpretation of the analytical results is effective and useful and, equally important, (ii) the conditions under which the results or the standard interpretation is not effective or reliable are understood. The minimal criteria are shown in Table 2 (these criteria are similar to those used to validate methods for use in clinical laboratories [6, 9, 10]).
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TABLE 2. Elements of a validation plan
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A validation plan also needs to address a range of possible relevant conditions that will be evaluated by assessing both reference and, at minimum, mock forensic samples. The samples should cover the relevant domain represented by the population for which the assay is to be validated. The test conditions should span a range of performance criteria. This range of criteria should include the conditions used by the anticipated SOP and indicate where the process begins to and will fail (for example, when the amount of material tested falls below the level of sensitivity of detection).
Once the criteria of a validation plan are satisfied, the procedure itself should be documented by preparing an SOP. Just as documenting the collection and the handling of evidence memorializes the history of an evidentiary sample from initial identification through analysis, a proper SOP should be written with the same detail in mind. This SOP may encompass all processes from collection to data interpretation or portions of the entire process. The SOP is a precise set of instructions for carrying out a process or procedure. It should contain sufficient detail about the procedure so that anyone trained in that field could carry out the assay, and it should include, if appropriate, the following elements: a delineation of each step of the procedure, a list of proper controls (positive, negative, and/or internal), a list of all reagents and descriptions of how to prepare them, calibration requirements for equipment and tests, criteria for the analysis of results, criteria for the interpretation of results, a list of personnel requirements, reporting criteria, and a list of appropriate literature references that support the fundamental theory or established scientific basis of a method. Such data are important for establishing foundations that support the validity of the basic science or the specific method.
(i) Collection and preservation.
The proper collection and preservation of microbial forensic evidence are crucial to a successful investigation leading toward attribution (4). If existing evidence is collected inefficiently, degrades, or is contaminated during collection, handling, transport, or storage, the subsequent characterization and attribution analyses may be compromised. Retrieving sufficient quantities and maintaining the integrity of the evidence increase the chances of characterizing the material to obtain the highest possible level of attribution. Thus, methods involved in this aspect of microbial forensics should be validated, as well as is possible, given that each crime scene is unique and all scenarios are not predictable or completely definable. In many undefined situations, it may be more appropriate to develop and validate more-generic approaches. Table 3 illustrates minimum elements to consider for collection and preservation criteria.
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TABLE 3. Checklist of elements of collection and preservation criteria
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(ii) Extraction of target for analysis.
The extraction of the target from a collected sample may not be necessary before direct analysis. Examples of this are the collection of bacteria from surfaces by using replicate organism direct agar contact plates for culture and the direct collection of visible powder for microscopy (19). In contrast, an extraction process is often necessary in microbial forensics analysis as a sample-processing step between collection and analysis. It may be necessary to extract the target from the collection device (swab, wipe, or filter, etc.), purify the target from the environmental matrix or substrate before analysis, and/or remove inhibitors that may affect subsequent analyses.
Furthermore, genetic analysis of organisms or trace analysis of nucleic acid remnants from some toxin preparations may require the adaptation of a sample-processing procedure. A wide variety of options exist for extracting nucleic acids for analysis. To validate new nucleic acid extraction procedures or modifications of validated procedures for application to new matrices or substrates, researchers may need to consider the nature of the sample being extracted and the potential adverse impact of contaminants in the sample on later analysis. For example, soil samples often contain humic and fulvic acids that can inhibit the PCR (16, 25). Failure to address this effect may lead to false-negative results that might lead to an incorrect interpretation that the target was not present at some level of detection. Signature extraction is a destructive process. Therefore, undue consumption of precious evidence may occur if the extraction process is not well validated for the application. This is particularly important for trace evidence analysis. An SOP should describe the target extraction and, where appropriate, concentration of the target to be analyzed.
For the extraction of targets, a minimum checklist of validation criteria should consider several factors (Table 4).
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TABLE 4. Checklist of elements of the extraction validation criteria
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SOPs for chemical or molecular analysis should identify (i) all reagents critical to the procedure that should be tested before analyzing unknown samples; (ii) critical equipment, calibration, and certification requirements; and (iii) known positive-, negative-, and/or internal-control samples used with the analysis. A validation plan for the analytical portion should consider, when appropriate, a number of parameters (Table 5).
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TABLE 5. Parameters to consider in the analytic component of a validation plan
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(iv) Interpretation significance or weight of evidence.
Assays used in a forensic context usually have a purpose that goes beyond simply identifying or quantifying the presence of an analyte. More often, the result of the analysis is used as evidence to support some inference of forensic relevance. Examples of such inferences are that a particular agent was found in a particular place, that a particular pathogen was transmitted from a suspect to a victim, that a particular method was employed to generate the agent, and that the agent was produced within a particular time frame.
Simply stated, interpretation is the stage of evidence analysis where questions about such issues are addressed. Thus, in the context of microbial forensic evidence, the results of interpretation relate to the identification of the microbial components in the sample and possible source attribution of the samples in the evidence. The interpretation of evidence should be based on well-validated criteria that reflect the existing knowledge surrounding the analysis of the evidence, its collection and storage, and the handling procedures used.
When interpreting microbial forensic evidence, a qualitative and/or quantitative statement about the outcome of the analysis should be provided. The general approaches to these statements should be contained in the interpretation/reporting section of the SOP. The SOP should contain a description of the criteria to be used to assess the significance of results, such as analyte identification. Such criteria include thresholds and the significance of artifacts.
Validation determines the limits of a test. It does not mean that a test must be 100% accurate or have no false-positive or false-negative results to be considered useful. However, solely testing for an analyte may not be sufficient to consider a procedure validated. Often an interpretation of the result is necessary so that proper actions can be taken or decisions can be made, and these can be impacted by specificity and cross-reactivity. A clinical example with the inclusion or exclusion of a diagnosis of Lyme disease illustrates this point and the importance of the context and intended purpose of a test. Most current serologic assays for Lyme disease detect an antigen (flagellin) that also is found in the pathogen that causes syphilis (Treponema pallidum) (15) and thus can impact interpretations of what constitutes a positive test. For example, if a symptomatic patient in an area of Lyme disease endemicity has a positive enzyme-linked immunosorbent assay result, a physician's first inclination may be to treat the patient for Lyme disease. However, if the patient has a history of sexually transmitted disease, further testing is warranted for both syphilis and Lyme disease (22).
The use of the "rapid strep test" to diagnose a sore throat as an infection with group A beta-hemolytic streptococci is an example of a test with a substantial number of false-negative results (18, 26); yet the assay is very useful when a decision-making algorithm is followed (18, 26). The purpose of this test is to diagnose strep throat rapidly so that antibiotics can be administered immediately. The intent is to treat the patient effectively and to reduce contagion to others. A positive result for a patient with a sore throat is assumed sufficiently definitive to treat. However, a negative "rapid strep test" result, which is known to have a 10 to 20% false-negative rate, is followed up by traditional cultures before doctors conclude that the patient is not infected with group A beta-hemolytic streptococci. This also minimizes unnecessary antibiotic administration. Thus, having a significant false-negative rate does not mean that the procedure is not valid. The validation process determined the limitations of the test, and the physician must appreciate the limits in order to interpret the results properly and to decide what proper follow-up analyses may be needed (18, 26).
Validation should support or provide a basis for the elements relevant to the situation in which a test is being employed (Table 6).
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TABLE 6. Checklist of relevant elements of interpretation
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One example of dynamic validation arose through the BioWatch program. This program is a nationwide surveillance system for sampling air for the presence of selected pathogens. It should provide an early warning of a potential bioterrorism attack that is more timely than waiting for infected individuals to present to the health care system with symptoms. Material extracted from filter-collected air samples is extracted and subjected to real-time PCR analysis of DNA with primers specific for certain select agents. In October 2003 in the Houston, Texas, area, several BioWatch filters tested positive for Francisella tularensis (2). Because the pattern of positive results was not consistent with that of a deliberate release of F. tularensis, the interpretation was that these observations were due to a natural event. Soil and water samples collected proximal to the positive BioWatch samples were extensively characterized to determine the source of the positive results. DNA extracts of the environmental samples were screened first by typing the 16S rRNA gene to detect Francisella species and related organisms. Subsequent cloning and sequencing of the PCR products indicated the presence of a wide variety of Francisella-related species, some of which were quite distinct from known Francisella species and appeared to be new species or genera (2). These findings impact the specificity of the PCR-based assay and the ability to differentiate an agent introduced in a bioterrorism attack from a naturally occurring strain. In the concept of method validation, the specificity of the BioWatch tests was validated with existing data, as is any system. Now that a previously unknown type of Francisella that is positive by the BioWatch system has been found in the environment, the interpretation criteria for the F. tularensis assay should be modified and additional recommendations for follow-up analyses may be required. Given the unknown diversity of the microbial world, additional experience will be gained as more samples are analyzed and further optimization of the method may be indicated.
Accuracy: the degree of conformity between the result of a measurement and a true value of the analyte, target, or signature.
Analytical procedure: an orderly step-by-step procedure designed to ensure operational uniformity and to minimize analytical drift.
Attribution: the information obtained regarding the identification or source of a material to the degree that it can be ascertained.
Bias: systematic error in measurement of an analyte, target, or signature.
Biocrime or bioterrorism: the threat or use of microorganisms, toxins, pests, or prions or their associated ancillary products to commit acts of crime or terror.
Calibration: a set of operations that establish, under specified conditions, the relationship between values provided by a measuring instrument, a measuring system, and a known material or known values.
Control samples: test materials whose identity, type, and/or values have been established.
Internal control: a control sample placed in the same tube or well as the analyte, target, or signature that is being analyzed so that it will be subjected to the exactly the same conditions as the analyte, target, or signature.
Negative control: a sample similar in nature to what is being analyzed but which does not contain the analyte, target, or signature. This control is run in parallel with the analyte, target, or signature. A positive result from a negative control may invalidate an analysis.
Positive control or known sample: a test material intended for use in the quality control process whose identity, type, and/or values have been established. These controls are used for day-to-day monitoring of typing activities. Controls are well known and well characterized and are to be analyzed in parallel with the test samples in an assay. A negative or incorrect result from a positive control may invalidate an analysis.
Critical equipment or instruments: those requiring calibration prior to their initial use and on a regular basis thereafter.
Critical reagents: determined by empirical studies or routine practice to require testing on known samples prior to use with evidentiary materials in order to prevent unnecessary consumption of forensic samples.
Error: obtaining an incorrect value, or the difference between a measurement and a true value. Measurement error is composed of random variability and bias (systematic or nonrandom effects on the measurement).
Imprecision: the distribution of independent results of measurements or values derived under specified conditions.
Limit of detection: the lowest concentration of analyte, target, or signature that can be consistently detected in a specified sample and can be distinguished from a sample that does not contain the analyte, target, or signature.
Measuring range: a defined range or limits of values for an analyte, target, or signature within which error of measurement of a system or process is expected to lie.
Microbial forensics: a scientific discipline that examines microorganisms, toxins, pests, or prions or their associated ancillary products for source attribution.
Precision: a measure of the extent (or nearness) of variation in values obtained from replicate determinations. It conveys the degree of repeatability expected for additional replicate measurements or values. It does not necessarily convey trueness or accuracy.
Quality assurance: the system of management activities designed to ensure that a process, item, or service is of the type and quality needed. This includes monitoring activities that are intended to verify whether practices and test results are providing reliable and relevant information.
Quality control: a mechanism or laboratory activity intended to verify whether test conditions are functioning appropriately to yield reproducible results.
Reference material (certified or standard): a material for which identities, types, or values are certified by technically valid procedures and is accompanied by, or traceable to, a certificate or other documentation.
Repeatability: the degree of consistency between or among results from successive measurements of the same analyte, target, or signature obtained under the same conditions.
Reproducibility: the degree of consistency between or among results from successive measurements of the same analyte, target, or signature obtained under changed conditions.
Resolution: the smallest difference between measurements or values that can be reliably distinguished.
Sensitivity: the concentration of analyte, target, or signature that is necessary to produce a reliable result.
Specificity: the ability of an assay to measure or type the analyte, target, or signature that it is intended to analyze, even when other components in the sample may inhibit or interfere, cross-react, or compete with the assay.
Standards: defined analytes, targets, or signatures used to characterize the performance of an assay within defined limits.
Standard operating protocol: a set of explicit instructions (and necessary supporting documentation) for the operation of a specified procedure.
Traceability: the property of a result of a measurement whereby it can be related to appropriate standards, generally international or national standards or other documented mechanisms, through an unbroken chain of comparisons.
Trueness: the difference of a measurement or result from that of a true value, accepted standard, or expected value.
Validation: a process by which a procedure is evaluated to determine its efficacy and reliability for analysis. There are three categories of validation defined for microbial forensics: developmental, internal, and preliminary.
Developmental validation: the acquisition of test data and the determination of conditions and limitations of a newly developed methodology for use on samples. Developmental validation should be appropriately documented and should address specificity, sensitivity, reproducibility, bias, precision, false positives, false negatives, and determination of appropriate controls. Any reference database used should be documented.
Internal validation: an accumulation of test data within the laboratory to demonstrate that established methods and procedures perform within determined limits in the laboratory.
Preliminary validation: the acquisition of limited test data to enable an evaluation of a method used to assess materials derived from a biocrime or bioterrorism event. Also termed "validation on the fly," which is utilizing a process during exigent circumstances where the situation has not been encountered and standard operating protocols have yet to be developed.
[Note: "Analyte, target, or signature" is used generally and can be anything that may be analyzed, ranging from an intact viable microorganism to an ion.]
Published ahead of print on 25 July 2008. ![]()
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