One of the most important functions of the clinical microbiology laboratory is the identification of the etiology of sepsis. For this study, aliquots from 405 positive blood cultures were tested against a unique array of DNA probes directed against rRNA subsequences of bacteria and fungi for identification. Another 280 samples that were negative after 5 days of incubation were also tested. Blood culture bottles were incubated in a BacT/Alert3D instrument. For the rRNA assay, a 0.4-ml aliquot was removed, and the cells were pelleted by centrifugation. The pellet was washed and frozen at ؊70°C. Analysis of the pellet involved a lysis step and then the addition of samples to the reaction wells containing the probes in a microtiter plate format. Analysis was performed by using a hybridization protection assay. Results were taken through a series of deductive steps to obtain species, or in some cases genus, identification. Batch sample preparation required approximately 15 min, and sample analysis required another 60 min. Probe results were compared to conventional biochemical identifications. The probe test was negative for the 280 samples that were negative by the BacT/Alert 3D system and for another 21 samples that were false positive (the instrument signaled, but there was no growth). 75%) samples. This novel rapid molecular approach to the identification of bacteria and yeast in blood cultures was highly sensitive (100%) and specific (96%).Traditional culture and biochemical identification (ID) of microorganisms that cause bloodstream infections is currently the only routine method for detecting the etiological agents of sepsis. In the past 2 decades, techniques for culturing blood have gone from manual and visual methods to the use of automated continuous monitoring blood culture instruments, such as the Bactec (Becton-Dickinson), BacT/Alert3D (Organon Teknika, Durham, N.C.), and ESP (Trek Diagnostic Systems) systems. These instruments detect CO 2 gas production or consumption when organisms grow in a broth medium above a certain growth threshold. Typically, the average time to detection of a positive culture ranges from 6 to 60 h, depending on the organism group. After the instrument signals positive, a Gram stain and subculture are performed. From the time the blood culture is noted to be positive, ID and susceptibility testing of the isolate(s) can take an additional 24 to 72 h. Due to the high morbidity and mortality associated with sepsis, there remains a need for rapid organism ID and susceptibility testing.With the advent of molecular techniques, the goal of such rapid testing has become a closer reality for routine testing in the clinical laboratory. Numerous studies have documented the use of nucleic acid tests for rapid ID of positive blood cultures. Direct DNA probing of blood cultures using chemiluminescent labels has been used in several studies (4, 7;

No abstract

The remedial programme should aim to make up the deficit in primary and community health services in the capital, to bring them into line with national standards. Investment in the 46% of general practitioners' premises which the Tomlinson report identified as substandard will be needed. So will improvements in the quality and quantity of conventional primary and community health services currently available to Londoners. NON-STANDARD SERVICESA service development programme is needed to provide non-standard services to groups for whom the traditional model of primary care, based on serving a family of fixed abode, is inappropriate. These groups of Londoners are very diverse. They consist of highly mobile young people and families, commuters, and tourists, as well as disadvantaged groups such as refugees. They also include some people from ethnic minorities, homeless and rootless people, homeless families, and substance misusers.The small scale of primary and community health services give them the potential for meeting such diverse needs flexibly, in ways that institutions cannot. There are a wide variety of project based experiments to draw on when devising a pattem of services geared to the needs of marginalised groups: they include "sick bay" services for homeless and rootless people; services provided by salaried general practitioners or community nurses for families in bed and breakfast accommodation; interpretation and advocacy for people from ethnic minorities; and outreach teams for substance misusers and street and hostel dwellers with mental health problems.The

No abstract