bioMerieux SA · EURONEXT:BIM
bioMerieux SA — Investor Day (January 2006)
130 slides from bioMerieux SA's investor day presentation, Jan 24, 2006
Slide 1: Bacteriology Day: Built to Grow
Bacteriology Day: Built to Grow 24 January 2006
Slide 2: Disclaimer
Disclaimer This presentation contains forecasts or estimates on trends and/or objectives. They are subject to various uncertainties and risks such as, but not limited to, the commercial success of products, fluctuations in currency exchange rates, reforms of health insurances or changes of governmen
Slide 3: Today's Speakers
Today’s Speakers Alain Mérieux Benoît Adelus Dr. Christophe Mérieux Pr. Claire Poyart President Executive Vice President Senior Corporate Vice President Head of the Microbiology Lab R&D and Medical Affairs Cochin University Hospital - France Buzz Sztukowski Philippe Sans Thierry Bernard Vice Preside
Slide 4: Agenda for Today
Agenda for Today 10:15 Welcome Coffee 10:30 bioMérieux’s Business and Strategy 10:45 Bacteriology: Main Characteristics 11:00 Organization and Mission of a Clinical Bacteriology Lab 11:20 bioMérieux’s Offer and Competencies 11:50 Clinical Cases 12:10 The Future of Bacteriology 12:30 Q&A Session 12:5
Slide 5: bioMérieux: a Unique Position to Address New Challenges for the Public Health
bioMérieux: a Unique Position to Address New Challenges for the Public Health "4 000 décès sont dus chaque "Près de 12.000 personnes par an année à des infections "Les infections nosocomiales meurent en France à la suite de maladies nosocomiales. Pour lutter touchent, contractées à l'hôpital, les ma
Slide 6: Outline
Outline 1. bioMérieux’s Business and Strategy - Benoît Adelus 2. Bacteriology: Main Characteristics 3. Organization and Mission of a Clinical Bacteriology Lab 4. bioMérieux’s Offer and Competencies 5. Clinical Cases 6. Future of Bacteriology 7. Q&A 8. Business Review 9. Geographical Review and Speci
Slide 7: Our Mission
Our Mission X Be a major player in in vitro diagnostic at the forefront of worldwide infectious disease prevention and treatment X Contributing to enhance public health 14/06/2006 14:17 balthus\Communication\Roadshow Presentation\13 Balthus - Roadshow Presentation - long version.ppt 6
Slide 8: bioMérieux: a Major Player in Infectious Diseases Diagnostic
bioMérieux: a Major Player in Infectious Diseases Diagnostic X A 40-year experience in biology X Infectious diseases: the core business of the Company 7
Slide 9: bioMérieux: a Major Player in Infectious Diseases Diagnostic
bioMérieux: a Major Player in Infectious Diseases Diagnostic IVD Market bioMérieux 2005 Sales Breakdown by Pathology* Breakdown by Pathology Industrial Applications Others 5% Infectious 9% Others Industrial Diseases Infectious 15% Applications 23% Diseases 13% 67% Haematology 6% Cardio- Cardiovascul
Slide 10: bioMérieux: a Major Player in Infectious Diseases Diagnostic
bioMérieux: a Major Player in Infectious Diseases Diagnostic X A 40-year experience in biology X Infectious diseases: the core business of the Company z A €5.3 billion global market z Average annual growth: 5-6% X Leading positions z Infectious diseases - Market position: # 3 z Bacteriology - One of
Slide 11: bioMérieux: a Unique Expertise
bioMérieux: a Unique Expertise X The only Company to address infectious diseases through three key technologies Molecular Bacteriology Immunoassays Biology Infectious Diseases Bacteria X X X Virus X X Fungi X X X Parasites X X Industrial Applications X X X 10
Slide 12: bioMérieux Bacteriology Figures
bioMérieux Bacteriology Figures X 55% of clinical sales, 75% of industry sales X 2003-2005: 8% CAGR in clinical Industrial Applications 128 M€ Bacteriology bacteriology sales 476 M€ Others 13% X 2 new platforms and 20 reagents 128 M€ launched in the last 2 years 13% Mol. Biology 48% 3% X More than 1
Slide 13: A Global Reach for a Global Challenge
A Global Reach for a Global Challenge North America: 26% EMEA (Europe, Middle East, Africa): 57% 60% 43% X More than 130 countries X 35 subsidiaries X Over 100 distributors Latin America: 6% 29% Asia Pacific: 11% 54% % of 2005 Sales by Region Out of which % of sales in Clinical Bacteriology 12
Slide 14: bioMérieux: a Unique Position in Bacteriology
bioMérieux: a Unique Position in Bacteriology X Bacteriology, at the heart of the fight against infectious diseases z Solution against the resistance to antibiotics, sepsis or re emerging of tuberculosis z Contribution to the improved control of Hospital-Acquired Infections X bioMérieux's focus on t
Slide 15: Outline
Outline 1. bioMérieux’s Business and Strategy 2. Bacteriology: Main Characteristics – Dr. Christophe Mérieux 3. Organization and Mission of a Clinical Bacteriology Lab 4. bioMérieux’s Offer and Competencies 5. Clinical Cases 6. Future of Bacteriology 7. Q&A 8. Business Review 9. Geographical Review
Slide 16: Bacteriology: a Key Technology for the Study of Infectious Diseases Agents
Bacteriology: a Key Technology for the Study of Infectious Diseases Agents The different micro organisms X Bacteria Bacteriology Septicemia, Urinary Infections, Diarrhea, Pneumonia, Tuberculosis, Diphteria, Tetanus X Fungi Mycology Mycosis, Tinea X Viruses Virology AIDS, Hepatitis C, Rubella, SARS X
Slide 17: Open Doors to Bacteria
Open Doors to Bacteria X Normal flora: open cavities z Mouth z Ears z Respiratory tract z Intestinal tract z Genital tract z Skin X Always sterile: closed cavities z Blood z Cerebro-Spinal Fluid (CSF) z Urine z Skin = protection against infections z Respiratory, uro genital system are " open doors "
Slide 18: Morphological Classification of Bacteria
Morphological Classification of Bacteria X Shape and characteristics of grouping are specific to families of bacteria Cocci diplococci clusters chains Bacilli diplobacilli coccobacilli 17
Slide 19: Bacteria
Bacteria Streptococcus Staphylococcus X Cocci X Bacilli Listeria Salmonella Corynebacteria 18
Slide 20: Gram + Cocci
BIOME|RIEUX Gram + Cocci 19
Slide 21: Sick People: Bacteria Pathogenicity
Sick People: Bacteria Pathogenicity X Obligate pathogenic bacteria (Ex: meningococcus, pneumococcus, cholera, tuberculosis, tetanus,...) z Multiplication and dissemination within the organism z Virulent factors: Adhesion substance Enzyme secretion: lesions in host tissues Occasional toxin secr
Slide 22: Speed of Multiplication
Speed of Multiplication X Most of the time, division occurs every 20 minutes T0 : 2 bacteria of Escherichia coli z After 1 hour 16 bacteria z After 4 hours 8 192 bacteria z After 8 hours 33 554 432 bacteria z After 12 hours 137 438 953 472 bacteria X Multiplication speed depends on: z Temperature z
Slide 23: Top Ten Bacteria
Top Ten Bacteria 1. Escherichia coli 2. Staphylococcus aureus 3. Pseudomonas aeruginosa 4. Staphylococcus epidermidis 5. Streptocococcus agalactiae 6. Enteroccocus faecalis 7. Enterobacter aerogenes 8. Proteus mirabilis 9. Klebsiella pneumoniae 10. Enteroccus spp X 600 bacteria are of medical releva
Slide 24: Outline
Outline 1. bioMérieux’s Business and Strategy 2. Bacteriology: Main Characteristics 3. Organization and Mission of a Clinical Bacteriology Lab – Pr. Claire Poyart 4. bioMérieux’s Offer and Competencies 5. Clinical Cases 6. Future of Bacteriology 7. Q&A 8. Business Review 9. Geographical Review and S
Slide 25: Organization and Mission of a Clinical Bacteriology Lab
Organization and Mission of a Clinical Bacteriology Lab Pr. Claire Poyart Service de Bactériologie GH COCHIN-SVP Paris
Slide 26: Multiple Roles of a Bacteriology Laboratory
Multiple Roles of a Bacteriology Laboratory X Diagnosis X Antibiotic therapy advice X Epidemiological surveillance: multi-drug resistant bacteria (MDR) X New diagnostic tests X Identification of new bacterial species X Identification of new resistance mechanisms Pr. Claire Poyart - Service de Bactér
Slide 27: Diagnosis of a Bacterial Infection
Diagnosis of a Bacterial Infection X Strategy z Isolate and identify the organism responsible for an infection from samples and sometimes demonstrate a specific immune response X Direct diagnosis: demonstration z Detect the bacteria or its components z Grow and isolate the bacteria to identify it to
Slide 28: Clinical Specimens
Clinical Specimens X Body fluid collection z Driven by symptomatology and clinical examination z Performed: As soon as possible, before antibiotic therapy At the portal of entry of infection In blood, in case of dissemination (sepsis) In targeted organs (CSF, abscess, fluids...) Asepticall
Slide 29: How a Specimen is Processed
How a Specimen is Processed 1 2 3 4 Pr. Claire Poyart - Service de Bactériologie - GH COCHIN-SVP 28
Slide 30: 1st Step: Direct Diagnosis
1st Step: Direct Diagnosis X Test prescribed: direct examination & culture & AST sensitivity Examples: z Urine z Sputum z Pleural Fluid z Cerebrospinal Fluid (CSF) z Abscess X Goal: identify the bacterium responsible for the infection and determine its susceptibility to antibiotics Pr. Claire Poyart
Slide 31: Macroscopic Examination
Macroscopic Examination X Turbidity: urine, CSF, pleural or joint fluid, ... X Odor: characteristic of obligate anaerobe infections in a deep abscess X Consistency: diarrheal stools, … Pr. Claire Poyart - Service de Bactériologie - GH COCHIN-SVP 30
Slide 32: Microscopic Examination
Microscopic Examination X Mandatory: z Enables visualisation of bacteria and associated cells X Using an optical microscope Pr. Claire Poyart - Service de Bactériologie - GH COCHIN-SVP 31
Slide 33: Microscopic Examination without Staining
Microscopic Examination without Staining Microscope (x 40): X On a drop of specimen X Observation of: z Possible presence of bacteria: cocci, diplococci, coccobacilli, bacilli, chains, ... z Mobility type z Semi-quantitative or quantitative estimation of cells Pr. Claire Poyart - Service de Bactério
Slide 34: Microscopic Examination after Staining
Microscopic Examination after Staining Microscope (usually x 100) X Thin smear of the specimen X Staining to better visualize bacteria and/or cells X Differential staining: z Gram stain differentiates between G+ (purple) and G- (pink) bacteria X Gram staining enables: z Morphology characteristics z
Slide 35: Examples of Probable Diagnoses taking Clinical Examination into Account
Examples of Probable Diagnoses taking Clinical Examination into Account Pneumonia (A) Skin abscess (B) Meningitis (C) Pyelonephritis (D) Pr. Claire Poyart - Service de Bactériologie - GH COCHIN-SVP 34
Slide 36: Lab Results on Day of Testing
Lab Results on Day of Testing Results transmitted within 1 hour Pr. Claire Poyart - Service de Bactériologie - GH COCHIN-SVP 35
Slide 37: Cultures
Cultures X Isolation (mandatory): z Various media are used to meet nutritional and energy needs of the bacteria to be grown X Incubation time varies: z 18 to 24 hours at 37°C z Sometimes more: 2 to 21 days Pr. Claire Poyart - Service de Bactériologie - GH COCHIN-SVP 36
Slide 38: Culture Results on Day 1
Culture Results on Day 1 D0 D1 X Open questions: z Which bacterial species? z Susceptible to which antibiotics? Pr. Claire Poyart - Service de Bactériologie - GH COCHIN-SVP 37
Slide 39: Identification (ID) - Antibiotic Susceptibility Testing (AST) on Day 2
Identification (ID) - Antibiotic Susceptibility Testing (AST) on Day 2 X For most of the common bacteria, ID & AST are available within 18-24 hrs X Both operations are run at the same time Pr. Claire Poyart - Service de Bactériologie - GH COCHIN-SVP 38
Slide 40: Blood Culture: a Specific Case
Blood Culture: a Specific Case X Blood testing specificities: z Very few bacteria (less than 10 bacteria or CFU per ml of blood) z Therefore, no direct microscopic examination, and no direct inoculation of plates X First step: enrichment of bacteria z Blood culture bottles are stored for up to 5 day
Slide 41: Blood Culture
Blood Culture Pr. Claire Poyart - Service de Bactériologie - GH COCHIN-SVP 40
Slide 42: Percentage of Positive Cultures
Percentage of Positive Cultures 80 70 Blood Urine 60 Biopsy 50 % positive Respiratory 40 Stool 30 Skin 20 Pus 10 Genital 0 Type of Specimens Pr. Claire Poyart - Service de Bactériologie - GH COCHIN-SVP 41
Slide 43: Cochin-St Vincent de Paul Hospital (1,300 beds) – Key Features for 2005
Cochin-St Vincent de Paul Hospital (1,300 beds) – Key Features for 2005 X 82,220 hospital admissions X 542,520 consultations X 84,000 emergency admissions X Clinical bacteriology laboratory z 175,500 samples / year Î 465 / day z 22,000 blood cultures / year Î 60 / day z 25,000 urine cultures / year
Slide 44: ID & AST Figures for 2005
ID & AST Figures for 2005 X 22,000 blood cultures / year: 6% positive z 1,320 ID & AST X 25,000 urine cultures / year: 35% positive z 8,750 ID & AST X 75,000 samples: 25% positive, on average z 18,750 ID & AST Total: 28,820 ID & AST in one year Pr. Claire Poyart - Service de Bactériologie - GH COCHI
Slide 45: Outline
Outline 1. bioMérieux’s Business and Strategy 2. Bacteriology: Main Characteristics 3. Organization and Mission of a Clinical Bacteriology Lab 4. bioMérieux’s Offer and Competencies – Dr. Christophe Mérieux 5. Clinical Cases 6. Future of Bacteriology 7. Q&A 8. Business Review 9. Geographical Review
Slide 46: bioMérieux: Products and Services to the Healthcare System
bioMérieux: Products and Services to the Healthcare System Hospital Public Health Reagents Biological analysis Instruments prescription Prevention Software Therapy Results Services Follow up Hospital or commercial Lab Physician Physician Office Lab Biological Consultation sample Patient 45
Slide 47: A Very Comprehensive Range of Products
A Very Comprehensive Range of Products X Three main stages: z Culture z Identification and antibiotics susceptibility testing z Results and Advice 46
Slide 48: A Very Comprehensive Range of Products
A Very Comprehensive Range of Products X Culture z Culture Media Dehydrated media Ready-to-use bottles Ready-to-use plated agar (PPM): conventional and chromogenic z Blood culture Manual range: hemoline bottles Automated range: BacT/ALERT® bottles X Identification and susceptibility testin
Slide 49: A Very Comprehensive Range of Products
A Very Comprehensive Range of Products Blood sample, a specific process Culture Identification / AST Advice 48
Slide 50: A Very Comprehensive Range of Products
A Very Comprehensive Range of Products Other samples Ex: urine sample Culture Identification / AST Advice 49
Slide 51: A Very Comprehensive Range of Products
Culture ID / AST Advice A Very Comprehensive Range of Products Blood sample Culture Identification / AST Advice Other samples 50
Slide 52: Culture Media
Culture ID / AST Advice Culture Media X Conventional media z Culture and isolation z Orientation (optional) X Chromogenic media z Culture and isolation z Identification X Over 100 million PPM per year X About 10 new media per year (new generation or new products) 51
Slide 53: bioMérieux Permanent Innovation
Culture ID / AST Advice bioMérieux Permanent Innovation Chromogenic PPM: Culture and Identification X CPS ID chromogenic PPM enables culture and identification E.coli Enterococci Proteus 52
Slide 54: bioMérieux Permanent Innovation: Automation
Culture ID / AST Advice bioMérieux Permanent Innovation: Automation X Benefits from automation in specific situations BacT/ALERT® Blood culture Automated growth detection Manual culture TEMPO ® (industry food samples) Automated growth and group identification X Automation brings: Quality z Standardi
Slide 55: Blood Culture System: BacT/ALERT 3D Family
Culture ID / AST Advice Blood Culture System: BacT/ALERT® 3D Family BacT/ALERT 3D 120 Combination Unit (120 cells) BacT/ALERT 3D 240 (240 cells) BacT/ALERT 3D 60 X About 50 million bottles per year (60 cells) 54
Slide 56: Identification (ID) Antibiotic Susceptibility Testing (AST)
Culture ID / AST Advice Identification (ID) Antibiotic Susceptibility Testing (AST) X From manual to automated solutions X Products: z To identify bacteria z To test their susceptibility to antibiotics z Targeting 2 markets clinical industrial 55
Slide 57: Identification (ID) Antibiotic Susceptibility Testing (AST)
Culture ID / AST Advice Identification (ID) Antibiotic Susceptibility Testing (AST) X From manual to automated solutions: API® strips Manual ATB™ galleries VITEK® range ID/AST Semi automated ID/AST Automated ID/AST X Automation brings: Quality z Standardisation Time to result z Continuous monitoring
Slide 58: Identification (ID) Antibiotic Susceptibility Testing (AST)
Culture ID / AST Advice Identification (ID) Antibiotic Susceptibility Testing (AST) Manual and semi-manual ranges X API® strips X ATB™ galleries
Slide 59: Identification (ID) Antibiotic Susceptibility Testing (AST)
Culture ID / AST Advice Identification (ID) Antibiotic Susceptibility Testing (AST) Automated ranges X VITEK® 2 / VITEK® 2 Compact: cards X Identification: z VITEK 2 cards: from fluorimetry to colorimetry X Antibiotic susceptibility testing: z ATB™ galleries: 24 hours and Rapid (4-5 hours) z VITEK 2
Slide 60: Results and Advice: Expert Systems
Culture ID / AST Advice Results and Advice: Expert Systems X Integrated knowledge data bases z ATB™, AES, AES-PC Integration of patient results Resistance phenotypes: identification and alert Therapeutic advice 59
Slide 61: Data Management and Therapeutic Advice
Culture ID / AST Advice Data Management and Therapeutic Advice Demographic data patients and samples BacT/LINK® VITEK® 2 range Results LIS BCI Blood Culture and Patient files/samples ID/AST Results Blood culture results Patient files/samples BacT/ALERT® range 60
Slide 62: bioMérieux's Project Portfolio: Major Trends
bioMérieux’s Project Portfolio: Major Trends X New culture media (including chromogenic) X Menu extension on existing platforms z VITEK® 2: permanent improvements (new species, new antibiotics) X BacT/ALERT® and other platform improvements: z Ergonomy improvement z Time savings X Expert systems and
Slide 63: Bacteriology Combined with Molecular Biology Brings Added Value
Bacteriology Combined with Molecular Biology Brings Added Value incubation 18-24 hrs mini API®, VITEK® ID/AST Culture media Samples Specific situations Fastidious Bacteria: Tuberculosis… NucliSENS EasyQ® 62
Slide 64: Bacteriology Combined with Molecular Biology Brings Added Value
Bacteriology Combined with Molecular Biology Brings Added Value incubation 18-24 hrs mini API®, VITEK® ID/AST Culture media Samples Specific situations Screening: MRSA, main pathogens NucliSENS EasyQ® 63
Slide 65: Bacteriology Combined with Molecular Biology Brings Added Value
Bacteriology Combined with Molecular Biology Brings Added Value incubation 18-24 hrs mini API®, VITEK® ID/AST Culture media Samples Specific situations Emergency: Meningitis… GeneXpert® Total time to identification 3 hrs 64
Slide 66: Outline
Outline 1. bioMérieux’s Business and Strategy 2. Bacteriology: Main Characteristics 3. Organization and Mission of a Clinical Bacteriology Lab 4. bioMérieux’s Offer and Competencies 5. Clinical Cases – Dr. Christophe Mérieux 6. Future of Bacteriology 7. Q&A 8. Business Review 9. Geographical Review
Slide 67: Urinary Tract Infection
Urinary Tract Infection X Repeated urinary tract infections in a 30 year woman; several antibiotic treatments were inefficient X Urine sampling X Lab testing: z Isolation of the bacteria on bioMérieux’s CPS ID chromogenic media Ö identification to the species (E. coli) z Antibiotic susceptibility te
Slide 68: Urinary Tract Infection
Urinary Tract Infection Urine Culture on CPS ID VITEK® 2 Card AST on VITEK ® 2 ÆE. coli Process completed in 24 hours 67
Slide 69: Sepsis
Sepsis X Admission in Intensive Care Units of a shocked patient (low blood pressure, skin signs, …) with confusion and fever X Suspicion of meningitis X Antibiotherapy (ampicillin) X Blood sampling and CSF sampling by lumbar puncture X Lab testing: z Blood culture on bioMérieux’s BacT/ALERT® system
Slide 70: Sepsis
Sepsis Blood and Blood culture on Culture ID and AST on ATB™ Expression CSF BacT/ALERT® sampling Process completed in 48 hrs (CSF) and 72 hrs (blood) 69
Slide 71: Nosocomial Pneumonia
Nosocomial Pneumonia X Aggravation of a pulmonary infection with a respiratory failure in a 83 year patient, hospitalised for cardiac trouble X First line therapy for 5 days X Bronco-alveolar specimen for diagnosis X Lab testing: z Culture of the bacteria on bioMérieux’s chromogenic media SA ID z Is
Slide 72: Nosocomial Pneumonia
Nosocomial Pneumonia Specimen of Culture on SA ID AST on VITEK® 2 bronchial liquid Process completed in 24 hours 71
Slide 73: Health Care Associated Infections, a Major Concern
Health Care Associated Infections, a Major Concern Medical staff Infected Infected Non infected patient? patient patient Environment Devices: air, water, … 72
Slide 74: Health Care Associated Infections, a Major Concern
Health Care Associated Infections, a Major Concern 3 M patients Worldwide MRSA €24 Bn Health Care Associated Infections (HCAI) 15 M patients Worldwide €35 Bn Health Care Associated Infections X35% of HCAI are multi-resistant X30% can be prevented XFrance: • half a million patients infected per year,
Slide 75: Outline
Outline 1. bioMérieux’s Business and Strategy 2. Bacteriology: Main Characteristics 3. Organization and Mission of a Clinical Bacteriology Lab 4. bioMérieux’s Offer and Competencies 5. Clinical Cases 6. Future of Bacteriology – Pr. Claire Poyart 7. Q&A 8. Business Review 9. Geographical Review and S
Slide 76: The Future of Clinical Microbiology
The Future of Clinical Microbiology Pr. Claire Poyart Service de Bactériologie GH COCHIN-SVP Paris
Slide 77: Clinical Microbiology: a Permanent Evolution
Clinical Microbiology: a Permanent Evolution X Clinical microbiology evolves in response to clinical needs X Many advances during the past decade z Automation Automated blood-culture Systems for phenotypic identification Antibiotic susceptibility testing and computerized interpretation systems
Slide 78: However, all these methods detect a phenotype
However, all these methods detect a phenotype One question of major importance: Does detection of the genotype constitutes the only future of clinical microbiology? Certainly not Pr. Claire Poyart - Service de Bactériologie - GH COCHIN-SVP 77
Slide 79: New Technologies
New Technologies X Genotypic methods in clinical microbiology Pr. Claire Poyart - Service de Bactériologie - GH COCHIN-SVP 78
Slide 80: Detection
Detection Number of bacteria Method Threshold 10 6 1 ng Microscope > 105-106 bacteria 5 10 0,1 ng Antigen > 105 bacteria 10 4 0,01 ng 3 10 1 pg Probes > 103-105 bacteria 2 0,1 pg 10 10 0,01 pg Branched probes > 101-103 bacteria 1 1 fg Amplif./culture > 1-102 bacteria Pr. Claire Poyart - Service de B
Slide 81: Current Molecular Technologies
Current Molecular Technologies X Sequenced based identification of micro organisms X Quantitative amplification z Real-time amplification z +++ viruses (HIV, hepatitis C) X DNA microarrays z DNA chips Pr. Claire Poyart - Service de Bactériologie - GH COCHIN-SVP 80
Slide 82: DNA amplification and sequencing process
Amplification Bacteria DNA (20 - 60 cycles) extraction Taq DNA pol Tissue specimen Phylogenetic tree 1 2 Data base sequencing M.W. electrophoresis Pr. Claire Poyart - Service de Bactériologie - GH COCHIN-SVP 81
Slide 83: Molecular Technologies
Molecular Technologies X Main interest for: z Slow growing bacteria Mycobacterium tuberculosis z Uncultivable or fastidious or intracellular growing bacteria Mycobacterium leprae (leprosis) Bacteria responsible of sexually transmitted diseases (STD) Treponema pallidum (syphilis) Chlamydia
Slide 84: Other Future Technologies
Other Future Technologies X Antigen microarrays for serology X Mass spectrometry X Transmission electronic microscopy Pr. Claire Poyart - Service de Bactériologie - GH COCHIN-SVP 83
Slide 85: Phenotype versus Genotype
Phenotype versus Genotype X Phenotypic detection z From bacterial culture z Detection of new mechanisms of resistance z Time: 18 to 24 h z Low cost X Genotypic detection z Without culture directly from the sample z Response: presence or absence (+ or -) z Rapid response < 2 hours z For antibiotic re
Slide 86: Phenotype and Genotype
Phenotype and Genotype X Are complementary z Identification Phenotypic methods identify more than 95% z Antibiotic susceptibility Molecular characterization of resistance gene Useful for fastidious bacteria Rapid detection of multiple resistant bacteria Meticilline resistant Staphylococcus
Slide 87: The Future in Communication and Organization
The Future in Communication and Organization X Microbial surveillance and reporting z The development of automated methods will allow A better follow-up of epidemiological trends A better surveillance of antibiotic resistance epidemiology Pr. Claire Poyart - Service de Bactériologie - GH COCHIN-
Slide 88: Outline
Outline 1. bioMérieux’s Business and Strategy 2. Bacteriology: Main Characteristics 3. Organization and Mission of a Clinical Bacteriology Lab 4. bioMérieux’s Offer and Competencies 5. Clinical Cases 6. Future of Bacteriology 7. Q&A 8. Business Review 9. Geographical Review and Specificities 10. Q&A
Slide 89: Outline
Outline 1. bioMérieux’s Business and Strategy 2. Bacteriology: Main Characteristics 3. Organization and Mission of a Clinical Bacteriology Lab 4. bioMérieux’s Offer and Competencies 5. Clinical Cases 6. Future of Bacteriology 7. Q&A 8. Business Review – Buzz Sztukowski 9. Geographical Review and Spe
Slide 90: Bacteriology
Bacteriology X Strong market position X Positioned for continued success X Creating future growth 89
Slide 91: Bacteriology: Strong Market Position
Bacteriology: Strong Market Position X Bacteriology is a cornerstone for infectious diseases diagnosis Industrial Applications Clinical 128 M€ Bacteriology 13% 476 M€ 48% Others 128 M€ 13% Molecular Biology 3% 27 M€ 23% Immunoassays 235 M€ bioMérieux 2005 sales by technologies 90
Slide 92: Bacteriology: Strong Market Position
Bacteriology: Strong Market Position X Clinical bacteriology market size in 2005: €1.5bn* X Unique market dynamics requires specific expertise By segment* By geography* ID/AST North America Culture Manual RoW 35% 40% 14% 12% Asia 13% 28% Pacific ID/AST 23% Auto 35% Blood Culture Europe * bioMérieux
Slide 93: Bacteriology: Strong Market Position
Bacteriology: Strong Market Position X Specific expertise and customer intimacy are required for success Growth rates * Key Drivers Healthcare Drivers 2004-2005 2006 + X Aging population X Increasing antibiotics resistance Culture [1% - 2%] [1% - 2%] X Hospital acquired infections Blood culture [4%
Slide 94: Bacteriology: Strong Market Position
Bacteriology: Strong Market Position X Total 2005 sales: 476 M€, growing 10% vs 2004 Culture ID/AST Manual 9% 13% X Conversion X VITEK® 2 technology Blood Culture 29% X Plastic bottles ID/AST Auto X Chromogenic media 49% X Integrated solutions bioMérieux 2005 clinical bacteriology sales by business
Slide 95: Bacteriology: Positioned for Continued Success
Bacteriology: Positioned for Continued Success Competitive environment* Competitive positioning* Blood ID/AST ID/AST Culture Culture Auto Manual bioMérieux Market sizes (in €M) 525 325 400 200 All Others ≈30% Market shares ≈25% bioMérieux >10% >40% >55% >20% Becton-Dickinson x x x x ≈5% Dade Behring
Slide 96: Bacteriology: Positioned for Continued Success
Bacteriology: Positioned for Continued Success Innovation Integration Outcomes X Strength of overall offering • Automation • Breadth of products offer X Strong offers work together • Scalable • Integration X Solution to the customer • Medical and economic value 95
Slide 97: Bacteriology: Creating Future Success
Bacteriology: Creating Future Success Business Segments Key success factors Competitive advantages Broad menu Leadership position in Europe X Culture X X Low manufacturing cost X X Reference method Installed base X A large installed base (about 10,000 X Blood Culture X X Product improvements to syst
Slide 98: Bacteriology: Creating Future Growth
Bacteriology: Creating Future Growth Differentiators X Expertise • Bacteriology • Information technology • Engineering X Breadth of product range • Integrated solutions X Customer intimacy • Global organization 97
Slide 99: Bacteriology: Success by Design
Bacteriology: Success by Design Business Segments X Culture X Blood Culture X Strengthening market position X Strategies build success X ID/AST Manual X Creating future growth X ID/AST Automated X Integrated Solutions 98
Slide 100: Outline
Outline 1. bioMérieux’s Business and Strategy 2. Bacteriology: Main Characteristics 3. Organization and Mission of a Clinical Bacteriology Lab 4. bioMérieux’s Offer and Competencies 5. Clinical Cases 6. Future of Bacteriology 7. Q&A 8. Business Review 9. Geographical review and specificities – Phili
Slide 101: Major Trends in U.S. Diagnostics Market
Major Trends in U.S. Diagnostics Market X Healthcare costs: 15% of GDP X Increased need for automation, due to labor shortage X New state legislation expected to face Hospital Acquired Infections X New quality / Patient safety initiatives X Consolidation of central laboratories: hospital and private
Slide 102: bioMérieux in the U.S. Market
bioMérieux in the U.S. Market X bioMérieux: a unique presence in the microbiology lab and within the whole hospital environment z More than 60% of all US hospitals use bioMérieux’s instrumentation z Presence in almost any automated Microbiology laboratory (installed base > 3,800 instruments) 3000 US
Slide 103: Clear Leadership Positions
Clear Leadership Positions X Clinical microbiology ID/AST - Market position: #1 z VITEK® 2 and VITEK 2 Compact z Automation and rapid results drive a leadership position z 62% of all automated US hospitals utilize VITEK technology X Clinical microbiology blood culture - Market position: #2 z BacT/AL
Slide 104: Microbiology: a Strategic 1%
Microbiology: a Strategic 1% Infection Microbiology Pharmacy Control HAI increase costs <1% 15 to 25% per event by $14,000 of Hospital Budget of Hospital Budget X Rapid, accurate microbiology results have a substantial impact on overall hospital costs and image X Initial therapies can be modified so
Slide 105: The U.S. Market: Bring Microbiology Beyond the Lab
The U.S. Market: Bring Microbiology Beyond the Lab X Leveraging lab Information Systems, infectious diseases diagnosis and patient data to deliver real-time patient therapy recommendation: Fewer medication errors Reduced hospital length of stay: average $2,000/day Minimization of hospital acqu
Slide 106: STELLARA: an Integrated Solution Offer
STELLARA®: an Integrated Solution Offer Physicians Pharmacists Microbiology OBSERVA® Lab 105
Slide 107: STELLARA: Reducing Medication Errors
STELLARA®: Reducing Medication Errors Case study X STELLARA® customer J. Kelly Martin (Director of Pharmacy of Franciscan Health System-Tacoma, Washington) As a result of using STELLARA®*: z STELLARA® implemented in January 2005 z Cost savings equivalent to the salaries for 40-person pharmacists sta
Slide 108: STELLARA: the Benefits of an Integrated Solution
STELLARA®: the Benefits of an Integrated Solution Traditional Microbiology Patient therapy changes Traditional Dr, Sees ID/AST results methodology ID/AST results complete Culture positive Culture collection 0 12 24 36 48 60 Hours With bioMérieux's Integrated Solutions bioMérieux’s integrated Patient
Slide 109: Clinical Diagnostics: Increasingly Critical
Clinical Diagnostics: Increasingly Critical Healthcare Trends Role of Diagnostics bioMérieux Offering 1. Uncompensated care and 1. Reduce length of stay 1. Real connectivity with operating costs on the rise STELLARA® pinpoints therapy and dosing 2. Shortage of technical talent 2. Automation and 2. I
Slide 110: Outline
Outline 1. bioMérieux’s Business and Strategy 2. Bacteriology: Main Characteristics 3. Organization and Mission of a Clinical Bacteriology Lab 4. bioMérieux’s Offer and Competencies 5. Clinical Cases 6. Future of Bacteriology 7. Q&A 8. Business Review 9. Geographical review and specificities – Phili
Slide 111: Emerging Asia: Strong Growth Potential for Automated Bacteriology
Emerging Asia: Strong Growth Potential for Automated Bacteriology X A huge and fast growing market: z China and India: a 2 billion+ population z The highest growth rate world wide of the IVD Market (China: +15%/year, India: +20%/year) X China: a limited access to healthcare z 20% of the worldwide po
Slide 112: Emerging Asia: Strong Growth Potential for Automated Bacteriology
Emerging Asia: Strong Growth Potential for Automated Bacteriology X Major challenges in infectious diseases: z Mortality: highest ratio infectious disease / metabolic disease z No improvement in health indicators despite extraordinary economic achievements z China: a patchy record on epidemic contro
Slide 113: Emerging Asia: Strong Growth Potential for Automated Bacteriology
Emerging Asia: Strong Growth Potential for Automated Bacteriology X Strong growth potential for bacteriology: z An underdeveloped market: 2 or 3% of total IVD Market vs 7% on a worldwide basis z Bacteriology will be core in a comprehensive approach such as for tuberculosis detection z Increasing a
Slide 114: Outline
Outline 1. bioMérieux’s Business and Strategy 2. Bacteriology: Main Characteristics 3. Organization and Mission of a Clinical Bacteriology Lab 4. bioMérieux’s Offer and Competencies 5. Clinical Cases 6. Future of Bacteriology 7. Q&A 8. Business Review 9. Geographical review and specificities – Thier
Slide 115: European Microbiology: Outpacing the Market
European Microbiology: Outpacing the Market X 2004 European IVD market*: 7.8 billion € +4.4% vs 2003 X Microbiology reagents market: 420 M€ in 2004 +3.8% vs 2003 Market bioMérieux 2004 Market* Growth* growth Culture 182 M€ +2.1% +6.6% Blood Culture 90 M€** +3.6% +4.5% ID-AST (reagents) 146 M€ +5.7%
Slide 116: European Microbiology: Top 5 Countries in 2005
European Microbiology: Top 5 Countries in 2005 X bioMérieux in: z France 73 M€ + 7.5% z Italy 28 M€ + 4.0% z Germany 28 M€ + 12.0% z Spain 19 M€ + 6.0% z UK 17 M€ + 9.0% 115
Slide 117: European Microbiology Market: Key Drivers
European Microbiology Market: Key Drivers X Market drivers: z More automation, more standardization z Accreditation z Price pressure z Consolidation of labs z Importance of rapid results z Hospital acquired infections z Growing importance of tuberculosis in Eastern countries z Buyers: bacteriologist
Slide 118: bioMérieux: Growth Opportunities
bioMérieux: Growth Opportunities X Foster focus on global solutions z Global solution for tuberculosis (molecular biology, bacteriology for ID and AST) z Data management software + concentrator of data z Pre Poured Media (PPM): be ready for coming antibiotic resistances Today, MRSA ID Tomorrow,
Slide 119: PPM Market: Leader in a Competitive Environment
PPM Market: Leader in a Competitive Environment X Market in 2004* z 182 million € z 2.1% growth z in volume (PPM + Home Made): 330 million plates, o/w 213 million PPM X bioMérieux market share z PPM + HM, in volume: 29% z PPM only, revenue or volume: 45% X Competition *EDMA source 2004 118
Slide 120: PPM market: Potential for Future Market Share Gains
PPM market: Potential for Future Market Share Gains X Market trends z 65% of the market is converted to PPM (estimated conversion rate: +5%) z Standardization, accreditation z Rationalization of staff z Price and commercial pressure from diagnostic companies X bioMérieux growth opportunities z Focus
Slide 121: Blood Culture Market: Increasing Leadership
Blood Culture Market: Increasing Leadership X Market in 2004*: z 90 million €** z 3.6% growth z Conversion of the market to automation already > 90% X bioMérieux: 50% market share X Competition *EDMA source 2004 **bioMérieux estimates 120
Slide 122: Blood Culture Market: Increasing Leadership
Blood Culture Market: Increasing Leadership X Market trends z Price (France, Germany…) z Global offer in bacteriology (ID-AST / Mycobacteria) z Data Management System z Safety issues z Ease of use X bioMérieux development opportunities Be faster than competitors z Argue on safety to limit impact of
Slide 123: ID AST Market: bioMérieux is the Partner of Choice
ID AST Market: bioMérieux is the Partner of Choice X Market in 2004*: z 146 Million € z 5,7% growth in value (flat in volume) X bioMérieux 2004 market share: 54% z Fostered by the success of VITEK® 2 Compact in 2005 X Competition z Limited penetration in the European market z Trying a come back in s
Slide 124: ID AST Market: Market Leadership with Clear Differentiation
ID AST Market: Market Leadership with Clear Differentiation X 2004 Market in volume: Automated ID Manual ID Automated AST Manual AST 35% 38% 65% 62% X bioMérieux global market share: 34% but 64% in automated ID AST X 2004 Market in revenue: Automated AST Manual AST Automated ID Manual ID 35% 48% 52%
Slide 125: ID AST Market: Key Drivers
ID AST Market: Key Drivers X Market drivers z Reduced lab operating costs: improved productivity, lower operating costs z Standardized testing process: improves result quality, simplifies training, minimizes errors z Flexible to conform to testing environment: HAI infections, multi-drug resistant ba
Slide 126: ID AST Market: bioMérieux's Growth Opportunities
ID AST Market: bioMérieux’s Growth Opportunities X Behave as a leader and change the market from manual to automation, thanks to an exceptional offer with VITEK® 2 and VITEK ® 2 Compact X Focus on: z A complete menu of tests for ID and for AST z Improve sensitivity to detect low level of resistances
Slide 127: DRG's Implementation: the German Case
DRG’s Implementation: the German Case X 2003: introduction of DRG in Germany X DRG requires to restitute diagnostics results of " basic " infections within 48 hrs to get benefit from reimbursement X For 37% of clinicians, rapidity and efficiency become key issues X Early processing of bacteriologica
Slide 128: DRG's Implementation in Germany: an Opportunity for bioMérieux
DRG’s Implementation in Germany: an opportunity for bioMérieux Evolution of IVD expenses in St. Bernward Krankenhaus – Hildesheim Microbiology Immuno-Haematology Immunology Haemostasis 2004 Haematology 2003 Urine Clinical Chemistry 0 50 100 150 200 700 800 ST. BERNWARD KRANKENHAUS – HILDESHEIM - Zen
Slide 129: Outline
Outline 1. bioMérieux’s Business and Strategy 2. Bacteriology: Main Characteristics 3. Organization and Mission of a Clinical Bacteriology Lab 4. bioMérieux’s Offer and Competencies 5. Clinical Cases 6. Future of Bacteriology 7. Q&A 8. Business Review 9. Geographical Review and Specificities 10. Q&A
Slide 130: bioMérieux: Key Expertise Leads to a Strong Platform for Growth
bioMérieux: Key Expertise Leads to a Strong Platform for Growth X Bacteriology, at the heart of the fight against infectious diseases z Solution against the resistance to antibiotics, sepsis or re emerging of tuberculosis z Contribution to the improved control of Hospital-Acquired Infections X bioMé