Rapid extraction from and direct identification in clinical samples of methicillin-resistant staphylococci using the PCR.

Methicillin-resistant staphylococci (MRS) are one of the most common causes of nosocomial infections and bacteremia. Standard bacterial identification and susceptibility testing frequently require as long as 72 h to report results, and there may be difficulty in rapidly and accurately identifying methicillin resistance. The use of the PCR is a rapid and simple process for the amplification of target DNA sequences, which can be used to identify and test bacteria for antimicrobial resistance. However, many sample preparation methods are unsuitable for PCR utilization in the clinical laboratory because they either are not cost-effective, take too long to perform, or do not provide a satisfactory DNA template for PCR. Our goal was to provide same-day results to facilitate rapid diagnosis and therapy. In this report, we describe a rapid method for extraction of bacterial DNA directly from blood culture bottles that gave quality DNA for PCR in as little as 20 min. We compared this extraction method to the standard QIAGEN method for turnaround time (TAT), cost, purity, and use of template in PCR. Specific identification of MRS was determined using intragenic primer sets for bacterial and Staphylococcus 16S rRNA and mecA gene sequences. The PCR primer sets were validated with 416 isolates of staphylococci, including methicillin-resistant Staphylococcus aureus (n = 106), methicillin-sensitive S. aureus (n = 134), and coagulase-negative Staphylococcus (n = 176). The total supply cost of our extraction method and PCR was $2.15 per sample with a result TAT of less than 4 h. The methods described herein represent a rapid and accurate DNA extraction and PCR-based identification system, which makes the system an ideal candidate for use under austere field conditions and one that may have utility in the clinical laboratory.

Anatomy of the Alzheimer's Respite Care Program (ARCP).

The Alzheimer's Respite Care Program is an innovative project designed to serve caregivers of Alzheimer's clients. This unique model offers both in-home and institutionally based respite care. Two community organizations which offer Adult Day Care respite forged a partnership to coordinate and expand their continuum of care, bringing many of the benefits of a day care setting into the home. This paper compares the original project conceptualization with its current design today. Factors affecting this evolution are explored together with program modifications incorporated to more appropriately respond to local needs. Key marketing strategies are discussed coupled with a presentation of program successes and recommendations for the future.