Patent Publication Number: US-8532934-B2

Title: Rapid and comprehensive identification of prokaryotic organisms by metagenomic analysis

Description:
RELATED APPLICATIONS 
     This application claims priority of U.S. Provisional Application No. 60/886,595, filed Jan. 25, 2007, and U.S. patent application Ser. No. 12/011,425 the content of which is hereby incorporated into this application by reference. This is a CONTINUING PATENT APPLICATION U.S. patent application Ser. No. 12/011,425. 
     BACKGROUND 
     1. Field of the Invention 
     The present disclosure pertains to methods for rapid detection and identification of microorganisms. More particularly, the disclosure relates to identification of prokaryotic organisms through molecular characterization of their genetic materials, such as DNA or RNA. 
     2. Description of Related Art 
     Microorganisms, such as bacteria, are a major cause of infections in higher mammals, including human. Although some infections may be treated without knowing the identity of the infectious agent, it is sometimes important for clinicians to know the identity of the infectious agent in order to prescribe the most effective treatment for the infection. This is particularly true for bacterial infections because different species of bacteria may respond differently to the same antibiotics. 
     In addition to their role as pathogens, prokaryotic microorganisms also play an important role in many industrial areas. Beer spoilage caused by bacteria has been a chronic problem for the beer industry. Prokaryotes are often found in various environmental contamination sites, and knowledge of the identity of these organisms can be useful for remediation. Identification of these prokaryotes may be instrumental for solving these problems. 
     Conventional methods for classification and identification of a microorganism require culturing of the microorganism, and typically rely on morphological or biochemical characteristics of the organism. The culturing step may delay identification, which can have consequences on the effectiveness of appropriate treatment, and may also increase exposure of laboratory workers to pathogens. The delay in identification may in turn increase the chances that the pathogens may be spread to others while awaiting lab test results. Moreover, the test results may be skewed when multiple microorganisms are present and the growth of one microorganisms inhibits the growth of others in the laboratory environment. There is therefore a need for a method which may rapidly identify the organisms without requiring culturing of the microorganisms in a laboratory environment. 
     Nucleic acid sequences of homologous genes have been used to distinguish different species. The differences in nucleotide usage, frequency and arrangement may indicate the degree to which different organisms have diverged from a common ancestor. U.S. Pat. No. 5,849,492 discloses a method for rapid identification of species based on taxonomically variable set of orthologous sequences, including ribosomal RNA genes. More specifically, the &#39;492 patent teaches a process whereby the sequences of ribosomal RNA molecules may be used to identify genetic differences between species. An information theory-based sequence analysis is used to select sequences in the homologous 16S ribosomal RNA genes (16S rDNA) for DNA amplification. The &#39;492 patent discloses a pair of primers amplifying orthologous ribosomal gene or RNA sequences that are selected using information theory-based methods that detect gene regions revealing sequences that are maximally divergent among multiple species, which make these primers and amplicons useful for identifying prokaryotes. However, there are limitations to the sensitivity and specificity of this method, because computational analysis in the &#39;492 patent was based on a multiple alignment of 16S rDNA sequences from only 55 prokaryotic organisms. 
     SUMMARY 
     It is hereby disclosed a methodology by which nucleic acid amplification is used to identify microorganisms without the need to culture the infectious agents. A single DNA amplification and sequencing assay (omnibus PCR) have been developed which may accurately identify a wide spectrum of infectious disease agents in vitro within a few hours after the specimen is collected. 
     U.S. Pat. No. 5,849,492 describes methods and primer sequences for 16S rDNA and 28S rDNA for identification of prokaryotic and eukaryotic organisms, respectively. The teachings of the &#39;492 patent are hereby expressly incorporated into this disclosure by reference. 
     The methodology disclosed here is an improvement upon the technology described in the &#39;492 patent. The present disclosure uses a more comprehensive set of orthologous gene sequences derived from a more diverse and larger set of taxa than those described in the &#39;492 patent to design primers that are capable of amplifying the 16S rDNA from a broader spectrum of prokaryotic species. As a result, a wider spectrum of organisms may be identified with the presently disclosed primers and methodology. 
     Since almost all organisms employ ribosomes to synthesize proteins, ribosomal subunits have been structurally and functionally conserved throughout the eons. Thus, ribosomal RNAs from widely differing species may differ in a small number of nucleotides. These limited sequence variations may be used to characterize the evolutionary or phylogenetic relationships between the organisms and to identify a specific organism. Briefly, information (in bits) may be used to precisely quantify both the similarities and divergence among 16S gene sequences, because information measures the number of choices between two equally likely possibilities (Schneider et al.,  J. Mol. Biol.  188: 415-431, 1986). Variable positions in a multiply aligned set of 16S rDNA sequences approach zero bits and homologous or highly conserved sequences have nearly two bits in a sequence logo (Stephens &amp; Schneider,  Nucl. Acids Res.  18: 6097-6100, 1990), which displays the average information content (R sequence ) and frequencies of each nucleotide at each position. 
     The average information in bits of a related set of sequences, R sequence , represents the total sequence conservation: 
                     R   sequence     =     2   -     [       -       ∑     b   =   a     t     ⁢       f   ⁡     (     b   ,   l     )       ⁢   log   ⁢           ⁢   2   ⁢     f   ⁡     (     b   ,   l     )             +     e   ⁡     (     n   ⁡     (   l   )       )         ]             I             
f(b,l) is the frequency of each base b at position l,
 
e(n(l) is a correction for the small sample size n at position l.
 
     A sequence logo may then be constructed based on the R sequence  to locate segments consisting of sequences with low information content flanked on either side by sequences with high information content. 
     Three different sets of PCR primers based on the 16S rDNA sequences from more than 2000 species were developed using the instant method and tested using both purified DNA from 100 different bacterial pathogens that are commonly found in hospital laboratories and with 299 uncultured clinical specimens of various types from patients with suspected bacterial infections. Primer set A (coordinates 931-1462 of the 16S rDNA sequence logo) may be used to amplify segments of the 16S rDNA product from prokaryotes. The other two sets of primers, B and C, which amplify sequences corresponding to coordinates 1819-2370 and 1819-2599 of the sequence logo, respectively, may be employed to confirm or refine the amplification results obtained using primer set A. 90% of the prokaryotic organisms identified with primer set A can be confirmed and in some instances, refined with primer sets B and C. 
     An improved method is also described for identifying more than one microorganisms present at the same infection site. Using the PCR and sequencing methodology described above, there may be instances where the sequence is not readable because there are multiple peaks at several locations in the sequence. To eliminate this problem, a constant denaturing gel electrophoresis (CDGE) protocol has been developed, which allows DNA to be separated on the basis of sequence composition and duplex stability in a vertical polyacrylamide gel. 
     The separated PCR products may be characterized based upon properties selected from the group consisting of nucleotide composition, base composition, nucleotide sequence, DNA structure, mass ratio of the DNA molecules or fragments derived therefrom, chemical reactivity of the DNA molecules, binding properties to other DNA molecules or proteins, thermal stability, and combination thereof. In another aspect, multiple PCR products may be separated and sequenced simultaneously using mass spectrometry. 
     In summary, it is disclosed here a number of oligonucleotides useful for taxonomic assignment of unknown species as well as for identification of clinically important pathogens. The method may generally include the following steps:
     (a) searching for a divergent segment of DNA with low average information content determined quantitatively surrounded by two conserved segments of said DNA with high average information content determined quantitatively;   (b) designing primers for PCR amplification of said divergent segment by constructing a sequence logo for said DNA such that said primers contain a set of sequences present in said sequence logo that encompass the nucleotide variability of said conserved segments, which primers can anneal to said conserved segments;   (c) amplifying said divergent segment of DNA by PCR technique using said primers to obtain PCR products;   (d) separating said PCR products based on the difference in sequences; and   (e) characterizing the separated PCR products based upon properties selected from the group consisting of nucleotide composition, base composition, nucleotide sequence, DNA structure, mass ratio of the DNA molecules or fragments derived therefrom, chemical reactivity of the DNA molecules, binding properties to other DNA molecules or proteins, thermal stability, and combination thereof.   

     In the case of pathogen identification, clinical samples are preferably processed to obtain a solution or suspension containing the DNA or RNA from the pathogens. Clinical samples may include, for example, blood, bone marrow aspirate, synovial fluid, biopsied samples, mucus, stool, urine, etc. In another aspect, the samples may be processed to remove certain impuritie that may impede the PCR reactions, such as red blood cells, salts, etc. At times, sample concentration or dilution may be needed to optimize the PCR condition. In yet another aspect, the method may further include a step wherein the existence of a pathological condition or a disease in an individual is determined base upon the identity of the organism obtained in steps (a)-(e) described above. 
     For purpose of this disclosure, pathogens may include bacteria, viruses, fungi and other clinically significant microorganisms generally known to the medical community For certain microorganisms that have RNA exclusively as their genetic materials, reverse transcription may be performed before subjecting the samples to PCR as described in Step (c). 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a flow chart showing the steps of the OmniAmp procedure. 
         FIG. 2  shows a sequence logo constructed based on the rDNA sequences from 2184 organisms obtained from Genbank v88; National Library of Medicine. 
         FIG. 3  is a color-coded windowed information plot showing the information content across the entire rDNA gene. 
         FIG. 4  shows Omnibus PCR analysis of diluted clinical samples containing infectious agents. 
         FIG. 5  shows results of Omnibus amplification of a representative sample of 23 different organisms. 
         FIG. 6  shows results of separation of PCR amplification products derived from the mixtures of infectious agents by CDGE. 
     
    
    
     DETAILED DESCRIPTION 
     Both the similarities and differences between microorganisms may be used to obtain the identity of these organisms. Morphological and biochemical properties have been used to differentiate among organisms, however, these methods can be time consuming and can be inaccurate, and if culturing conditions are not correct, may fail to identify the organism that is present in a specimen. According to the present disclosure, nucleic acid sequences of homologous genes in different species may reveal the identity of infectious agents. The frequency and arrangement of nucleotide differences indicate the degree to which two organisms have diverged from a common ancestor. In a preferred embodiment, the sequences of ribosomal DNA may be used to identify genetic differences between bacterial species. 
     In order to ensure that the widest spectrum of organisms may be identified, it is desirable to apply the information theory-based sequence analysis to a greatest possible number of species to select for sequences in the homologous 16S ribosomal RNA genes (16S rDNA) for DNA amplification. In one embodiment, full length 16S rDNA sequences from a set of bacterial species (2184 organisms obtained from Genbank v88; National Library of Medicine) having the broadest possible taxonomic distribution are used to design amplification experiments (Saiki et al.,  Science  230: 1350-1354, 1985). 
     The total information content at each position is the basis for selecting phylogenetically-informative regions flanked by &gt;18 bp segments showing sufficient sequence conservation to be used as primers for the PCR amplification reaction. The ratio of the number of bits of each nucleotide at each position to the total number of bits at that site may determine the proportion of a particular nucleotide at degenerate sites in the oligonucleotide primer. A ratio of 0.001 may be taken as the minimum proportion required to include this nucleotide in a degenerate site (see below). Otherwise, the primer may be designed to be homogeneous at that position. 
     A sequence logo may be used to locate several segments consisting of sequences with low information (&gt;100 nucleotides, average R sequence =0.2) content flanked on either side by sequences with high information content and tested experimentally (Rogan et al., 1995; Tooley P W, Salvo J J, Schneider T D, Rogan P K: Phylogenetic inference using information theory-based PCR amplification. J Phytopathology, 146(8-9): 427-430, 1998). 
       FIG. 1  illustrates a typical process for identifying unknown species in a sample. The main (central column) and contingency (left and right columns) procedures are all shown in the figure. The contingency procedure is invoked only if the main procedure does not provide the desired results at any given step. The main process may be automated at several steps, as indicated by the boxes with boldtype outlines. A laboratory robot and thermal cycler inside the biosafety cabinet may be used to carry out these steps. This should maximize safety and minimize errors in handling and tracking infectious specimens. 
     Briefly, a clinical specimen may be dispensed into a microtiter plate, and the organism(s) contained in the specimen may be killed by heat treatment. The sensitivity of detecting different organisms usually is not compromised by this method for releasing DNA. The bacterial 16S rDNA sequence may then be amplified, and the product may be purified, preferably by magnetic methods. PCR may be generally performed by following the methodology described by Mullis K B, Faloona F A, “Specific synthesis of DNA in vitro via a polymerase-catalyzed chain reaction,” Methods Enzymol. 1987; 155:335-50. The purified PCR product may then be cycle sequenced (using the original amplification primers for sequencing and a set of complimentary sequencing primers derived from a high-information content interval from within the amplification product; these sequencing primers are also designed to be degenerate so as to include the respective combinations of nucleotides present and in the same frequencies that these nucleotides are observed in the multiple alignment (in this case of 2184 sequences). A contig of redundant, overlapping sequences from the complementary sequences derived from both strands of the product may be constructed from the sequences produced using the internal sequencing primers and by using the amplification primers to initiate sequencing. 
     The resultant consensus sequence derived from the contig may then be compared with a database containing a large collection of ribosomal sequences from a large number of organisms. The database comparison may be carried out on a local computer or remotely through a web-based tool. For example, the National Center for Biotechnology Information&#39;s (NLM) Basic Local Alignment Search Tool may be used to carry out the sequence comparison to a database of ribosomal DNA gene sequences culled from GenBank or Ribosomal Gene Database entries. 
     The sequences showing the greatest similarity (and one distantly related sequence) may be multiply aligned with the test sequence. The Clustal program may be used for the alignment, and several different types of phylogenetic trees may be constructed demonstrating the taxonomic relationship between the test sequence and those derived from the other organisms. 
     Oligonucleotide DNA primers may be designed such that both the conserved regions and the divergent DNA sequences between them may be amplified (example shown below). The 3′ termini of these primers are preferably selected at positions in the sequence logo with maximal information content (as close to 2 bits as possible), so that the primer end is always complementary to any bacterial template that is found in the series of orthologous genes that is used to design them. The 5′ termini and internal primer positions of each primer are more permissive for degeneracy, with frequencies of each nucleotide corresponding to those given by the information analysis. This design may increase the efficiency of amplification, allowing the orthologous 16S rDNA sequences to be obtained from a maximum number of organisms. Oligonucleotide mixtures are defined by the frequencies of each nucleotide in the sequence alignment. This feature may maximize the sensitivity without sacrificing specificity for the 16S rDNA genes because these oligonucleotides are complementary to most potential genomic targets. A limitation of this method, however, is that omnibus amplification of genes whose functions and sequences are not widely conserved throughout the prokaryotic kingdom cannot be used to identify those species in which they are not found. Therefore, preferred genes used in this invention include those which perform functions that are necessary to provide essential or fundamental cellular functions (e.g. ribosomal genes needed for protein translation, cytochrome P450-related genes, ie. cytochrome b5, needed for oxidative respiration, other housekeeping genes). 
       FIG. 2  shows an example of a sequence logo constructed for the purpose of designing primers. The sequence logo indicates the sequence conservation among a multiple alignment of ribosomal small subunit 16S rRNA genes of 2251 prokaryotic species. The portion of the logo shown indicates the region used to select primer pair set A indicated in the specification. The height of each stack of letters depicts the overall conservation in bits of information at each position and the relative heights of each nucleotide correspond to the percentage of gene sequences at that position containing that nucleotide. The error bars of the computation of average information at each position are indicated at the top of each stack. The locations of the primers used for PCR amplification and DNA sequencing of the amplification products are presented using arrows (orientation corresponds to the strandedness of the sequence) below the logo at the corresponding numbered positions. The primers are named according to these coordinates. Note that the antisense primers indicated at positions 1268-1287 were used only for DNA sequencing of the product amplified by primer pair A (positions 931-949 and 1462-1439). 
       FIG. 3  shows a windowed information plot which indicates the information content across the entire rDNA gene. This figure is color coded by average information content which permits selection of high information content primer length windows separated by a low information content sequence region. Additional sets of primers may be designed in a similar fashion based on the information provided in  FIG. 3  as well as sequence logo similar to the logo shown in  FIG. 2 . Table 1 lists three sets of primers designed based on the methodology described above. 
     
       
         
           
               
             
               
                 TABLE 1 
               
             
            
               
                   
               
               
                 Degenerate primer sets derived by information analysis 
               
            
           
           
               
               
               
               
            
               
                 Primer Set 
                 A 
                 B 
                 C 
               
               
                   
               
               
                 Forward primer coordinates 
                 931/949 
                 1819/1839 
                 1819/1839 
               
               
                 Reverse primer coordinates 
                 1462/1439 
                 2391/2370 
                 2599/2578 
               
               
                   
               
            
           
         
       
     
     PCR products generated from primer set A are approximately 410 nucleotides long, and their DNA sequences may be determined by automated dideoxy methods using internal sequencing primers in less than 1 hour. This procedure simultaneously satisfies the requirements for broad specificity and for high sensitivity and does so rapidly (within a few hours) by comparison with conventional microbiological approaches. 
     If no amplified bacterial DNA is obtained from a human clinical sample using any of the primers for amplifying bacterial DNA, the sample may be subject to PCR amplification using a pair of test human primers. The test human primers may be a pair of primers that are capable of amplifying a segment of the human DNA. The test human primers preferably anneal to a segment of the human DNA that is highly conserved. If no PCR products are obtained using the test human primers, it is likely that PCR inhibitors may be present in the PCR reaction, because human DNA is abundantly present in the human clinical samples. Conversely, if the expected PCR products are obtained using the test human primers, the bacterial primers may not be suitable for amplifying the unknown species, or there may not be sufficient amount of bacteria in the sample. 
     If it is determined that PCR inhibitors may be present in the PCR reaction and inhibits DNA amplification, the clinical samples may be diluted. For instance, the 50 ul, and 500 ul centrifugation steps in the standard sample preparation described in Example 1 may be used. If these steps do not solve the problem, it may be necessary to dilute the sample to a higher degree than that used in the standard sample preparation in order to dilute out any possible inhibitors of PCR in the sample. PCR inhibition may be tested by using human ribosomal DNA primers in the PCR reaction as illustrated in Example 1. 
       FIG. 4  shows Omnibus PCR analysis of diluted clinical samples containing infectious agents. Samples 22, 27 and 58 and 70 were diluted 1:5, 1:10, 1:20 and 1:40 and amplified with primer set A which produces a single PCR product of 415 bp. The human genomic DNA control [H] did not yield a band that comigrated with either  E. coli  (E) or the other bacterial amplification products. Although in this instance all of the dilution produced amplification products, frequently only a subset of dilutions will yield a result. 
       FIG. 5  shows results of Omnibus amplification of a representative sample of 23 different organisms. The first 4 organisms were amplified with a different set of omnibus primers from the remaining species (which were amplified using primer set A). Except for  T. globrata  and  C. albicans , which are fungal agents, most of the bacterial organisms produce the expected 415 bp product. 
     The PCR product may be purified using a number of established methods for DNA purification. Preferably, the PCR product is purified using magnetic separation, or gel purification. Magnetic separation may have a higher yield of recovered PCR product than gel purification. At least one primer may be biotinylated if magnetic separation of PCR product is to be used. Although gel purification produces relatively lower yield and requires higher amount of the amplified DNA, gel purification has proven helpful in some instances in reducing the problem of concatomers of PCR products that may cause difficulty in obtaining clean sequence data. One potential drawback for gel purification is that it may not be as conducive to automation as magnetic separation. Magnetic separation is the preferred method for purifying the PCR products. 
     The purified PCR products may be characterized by sequencing or other molecular tools. Sequencing methods such as the dideoxy method or the chemical method may be used. See Sanger F, Nicklen S, Coulson A R, “DNA sequencing with chain-terminating inhibitors.” Proc Natl Acad Sci USA. 1977 74(12):5463-7; and Maxam A M and Gilbert W, “Sequencing end-labeled DNA with base-specific chemical cleavages.” Methods Enzymol. 1980; 65(1):499-560. The sequences may be read from a film exposed to the sequencing gel or may be obtained using an automated sequencing machine. 
     Mass spectrometry may also be used to sequence DNA molecules. Briefly, conventional chain-termination reactions may be used to produce DNA molecules of different lengths and the length of these fragments is then differentiated based on the mass differences between them. See e.g., Martin, Genome, 31: 1073, 1989; Nelson et al. Science. 246: 1585, 1989; Jacobsen et al. Genet Anal Tech Appl. December; 8(8):223-9, 1991; Tang et al. Rapid Communications in Mass Spectrometry, Volume 6, Issue 6, Pages 365-368, 1992; Parr et al. Rapid Communications in Mass Spectrometry, Volume 6, Issue 6, Pages 369-372, 1992; Fitzgerald et al. Rapid Communications in Mass Spectrometry, Volume 7, Issue 10, Pages 895-897, 1993; Wu et al. Anal Chem 66: 1637-1645, 1994; Siuzdak. Proceedings of the National Academy of Sciences, Vol 91, 11290-11297, 1994; Little et al. J. Am Chem Soc. 116: 4893-4897, 1994; Tang et al. Nucleic Acids Res. 1995 August 25; 23(16): 3126-3131., 1995; Little and McLafferty. J Am Chem Soc 117, 678306784, 1995; Nordhoff et al. J. Mass Spectrometry, 30(1):99-112., 1995; Barry et al. J. Mass Spectrometry, Volume 30, Issue 7, Pages 993-1006, 1995; Little et al. Proceedings of the National Academy of Sciences, Vol 92, 2318-2322, 1995; Ni et al. Anal. Chem., 68 (13), 1989-1999, 1996; Little et al. J. Am. Chem. Soc., 118 (39), 9352-9359, 1996; Koster et al. Nat Biotechnol. 1996 September; 14(9):1123-8; Murray, K. DNA sequencing by mass spectrometry, J. Mass Spectrometry, V. 31, 1203-1215, 1996; J. R. Edwards, H. Ruparel, and J. Ju. “Mass-spectrometry DNA sequencing”.  Mutation Research  573 (1-2): 3-12 (2005); and U.S. Pat. Nos. 5,691,141, 6,225,450, and 6,268,131. All these references are hereby incorporated by reference into this application. 
     Other molecular tools capable of discerning the difference in DNA structures may also be used to characterize the PCR products. See, e.g., V. K. Khanna, “Existing and emerging detection technologies for DNA (Deoxyribonucleic Acid) finger printing, sequencing, bio- and analytical chips: A multidisciplinary development unifying molecular biology, chemical and electronics engineering” Biotechnology Advances, 2007, 25:85-98, which is hereby incorporated by reference. 
     If conventional DNA sequencing is used, when the sequencing run is finished, DNA sequence analysis software, such as Visible Genetics OpenGene, may be used to align and base call the electropherogram. Preferably, the sequence data are manually checked and edited to obtain as clean and accurate a sequence as possible prior to sequence analysis. In some situations, the electropherogram may need to be manually aligned and/or base called because of the limitations of the software. 
     There may be instances where the sequence is not readable because there are multiple peaks at several locations in the sequence. The multiple peaks look a lot like background noise but are usually higher than background noise levels. This phenomenon is called “multiple infection” which refers to the presence of more than one sequences in a sample. One way to determine if there is more than one sequence is to run the sequences on atblast which compares the suspected bacterial sequence with the database of 11,400 prokaryotic 16S rDNA sequences compiled from GenBank using the NCBI Blast software. This method may not work if the sequences can not even be determined in the first place. The sequences derived from most multiple infections will only match approximately 10-30 nucleotides (which is not statistically significant or adequate to determine the identity of the species) due to the resulting limited homology to any single organism rDNA sequence. To solve this problem of deconvoluting the sequences of multiple organisms, a Constant Denaturing Gel Electrophoresis (CDGE) protocol is developed which separates the amplicons produced by each of the species, so that they can be sequenced independently of one another. CDGE may allow DNA to be separated on the basis of sequence in a vertical polyacrylamide gel.  FIG. 6  shows a typical CDGE gel which separates the omnibus amplification products from multiple species. 
     Alternatively, mass spectrometric methods may be employed for simultaneous identification of multiple biomolecular targets. When two or more targets are of similar sequence composition or mass, they may be differentiated by using special mass modifying, molecular weight tags on different targets. These mass modifying tags are typically large molecular weight, non-ionic polymers including but not limited to, polyethylene glycols, polyacrylamides and dextrans. These tags are available in many different sizes and weights, and may be attached at one or more different sites on different nucleic acid molecules. Thus similar nucleic acid targets may be differentially tagged and may now be readily differentiated, in the mass spectrum, from one another by their distinctly different mass to charge ratios. According to this disclosure, the identification process may be significantly accelerated because multiple species may now be identified simultaneously without separating them first. 
     The following examples illustrate the present invention. These examples are provided for purposes of illustration only and are not intended to be limiting. The chemicals and other ingredients are presented as typical components or reactants, and various modification may be derived in view of the foregoing disclosure within the scope of the invention. 
     Example 1 
     Clinical Sample Preparation 
     Materials 
     TE buffer 
     disinfectant and squirt bottle 
     empty container for disinfectant 
     0.2 ml strip tubes 
     0.2, 0.5, 1.5 ml tubes 
     pipettes and sterile pipette tips (1000 ul, 200 ul, 20 ul) 
     Red blood cell lysis buffer (if using samples containing blood) 
     General Strategy 
     
         
         1) Perform standard sample preparation procedure. 
         2) If this step doesn&#39;t result in an amplification product from the sample containing genomic sequences of the pathogen, it is necessary to concentrate the sample by centrifugation of 50 ul or, if available, 500 ul of the sample at high speed (&gt;13000 g). This concentrates the sample containing the template and increases the chance of obtaining an amplification product. 
         3) If the sample contains red blood cells (whether or not it is a sample of blood), perform sample preparation procedure for blood (#3).
 
Detailed Protocol
 
A. Standard Sample Preparation Dilution:
 
       
    
     Put on a disposable lab coat, mask, two sets of gloves and safety glasses 
     Label strip tubes with patient number for serial dilution (4 tubes from strip, 1:6, 1:20, 1:50, 1:100) 
     To the appropriate labeled tube add the following
         100 ul TE (1:6)   46 ul TE (1:20)   30 ul TE (1:50)   20 ul TE (1:100)       

     Cap each tube securely 
     Take tubes, samples, tips, pipettes, and disinfectant to a biological safety hood 
     Fill disposable box halfway with disinfectant for contaminated tip and tube disposal 
     Transfer three 250 ul aliquots of each sample to three labeled 0.5 ml microfuge tubes (to work with) 
     Flame the opening of the original clinical specimen tube after opening and before closing 
     Place 20 ul of sample into the 1:6 tube and mix thoroughly
         take 20 ul of 1:6 and place into 1:20 tube and mix thoroughly   take 20 ul of 1:20 and place into 1:50 tube and mix thoroughly   take 20 ul of 1:50 and place into 1:100 tube and mix thoroughly   recap tubes tightly and place used tip into disinfectant       

     Place tubes in thermal cycler and perform Hotstart to kill bacteria
         94° C. for 15 minutes   4° C. for infinity       

     Clean and sterilize hood, dispose of all contaminated materials in biological waste container 
     Store remaining clinical sample aliquots and dilutions at −20° C. 
     Perform PCR amplification on clinical sample dilutions 
     Typical results for 4 different clinical samples are presented below: 
     B. Sample Preparation Centrifugation: 
     Put on disposable lab coat, mask, double gloves and safety glasses. 
     Fill disposable box halfway with disinfectant for contaminated tip and tube disposal 
     If sample appears bloody, see section labeled sample preparation for samples containing blood 
     Aliquot 50 ul (or 500 ul if 50 ul centrifugation has shown no bacterial amplification) of each sample into a 1.5 ml tube. Make sure tubes are labeled with sample number and other pertinent data. 
     Centrifuge at 14000 rpm in microcentrifuge for 10 min. 
     Remove supernatant and discard into disposable box along with pipette tips. 
     Resuspend pellet with 400 ul TE. 
     Centrifuge at 14000 rpm in microcentrifuge for 10 min. 
     Remove and discard supernatant and tips as before. 
     Resuspend pellet in 50 ul TE, 75 ul TE if using 500 ul centrifugation 
     Transfer to a labeled 0.2 ml thin walled tube 
     Place tubes in thermocycler. 
     Run the “HotStart” program on the thermocycler. This heats the tubes at 94° C. for 15 min. to heat kill the bacteria 
     Clean and sterilize hood, dispose of box containing contaminated materials in biological waste container. 
     While heat kill program is running, prepare 0.2 ml strip cap tubes for serial dilution as follows: 
     1 st  tube straight, 2 nd  tube 1:6, 3 rd  tube 1:20 and 4 th  tube 1:50
         Place 100 ul TE into tube 2   Place 46 ul TE into tube 3   Place 30 ul TE into tube 4       

     When hotstart program is finished, place 20 ul sample into straight tube and 20 ul sample into 2 nd  tube labeled 1:6 and mix thoroughly 
     Take 20 ul from 1:6, place into 1:20 tube and mix thoroughly 
     Take 20 ul from 1:20 tube, place into 1:50 tube and mix thoroughly 
     Store remaining clinical sample aliquots and dilutions at −20° C. 
     Perform PCR amplification on sample dilutions 
     C. Sample Preparation for Samples Containing Blood* 
     Put on disposable lab coat, mask, double gloves and safety glasses. 
     Fill disposable box halfway with disinfectant for contaminated tip and tube disposal 
     Add 300 ul red blood cell lysis buffer to a labeled 1.5 ml microfuge tube 
     In a biological safety hood—add 100 ul sample to tube and mix 
     Incubate 10 minutes with periodic mixing 
     Centrifuge 11700 rpm (14500×g) for 1 min 
     Save pellet and discard of supernatant 
     Wash pellet with 300 ul red blood cell lysis buffer 
     Centrifuge 11700 rpm (14500×g) for 1 min 
     Save pellet and discard of supernatant 
     Resuspend pellet in 50 ul TE 
     Transfer to a labeled 0.2 ml thin walled tube 
     Cap tightly and place in thermalcycler, run HOTSTART (94° C. for 15 min.) to heat kill bacteria 
     Clean and sterilize hood, dispose of contaminated material in biological waste container 
     Set up sample dilutions the same as described under the section labeled “Sample Preparation Centrifugation” 
     Store remaining clinical sample aliquots and dilutions at −20° C. 
     Perform PCR amplification on clinical sample dilutions *Heme is an inhibitor of PCR 
     D. Preparation of Infected Solid Tissue Specimens for Bacterial DNA Amplification 
     
         
         1) Add PBS to thawed sample 
         2) Let stand for 15 minutes
       Alternative: If no amplification is obtained, rock on nutating platform 3-4 hours, then continue with step 3.   
     
         3) Remove PBS, centrifuge 
         4) Remove supernatant and wash pellet with TE 
         5) Centrifuge, resuspend in TE 
         6) Perform sample dilutions as in centrifugation sample prep. 
         7) If this does not work, grind tissue first with tissue grinder. 
       
    
     Example 2 
     Preparation of Sequence Logo 
     A sequence logo was created from the aligned 16S rDNA sequences, and a representative region having two conserved regions surrounding a divergent region is shown in  FIG. 2 . The horizontal axis represents nucleotide positions along the DNA, whereas the vertical axis measures the degree of conservation at the same position in the various species. The vertical scale is given in bits of information (or R sequence ), which measures the number of choices between two equally likely possibilities. R sequence  may be calculated according to Equation I. 
     The choice of one base from the 4 possible bases requires two bits of information. The two bits correspond to two choices. For example, the first choice could determine whether the base is a purine or a pyrimidine and the second choice would specify which purine or pyrimidine is present. Thus, if at a certain position, all of the aligned 16S sequences have the same nucleotide, then that position has two bits of conservation. Thus, in the logo of  FIG. 2 , that nucleotide appears at that particular position with a height of (almost) 2 bits. A small sample correction prevents it from being exactly 2 bits high (Schneider T. D. et al., 1986, J. Mol. Biol., 188:415-431). 
     For those positions where two equally likely bases occur, there is only one bit of information. This is because a choice of 2 things from 4 is equivalent to a choice of 1 thing from 2. By way of example, if at a particular position in a nine-sequence alignment, 5 of the sequences contain A and 4 have T, this position is about 1 bit high in  FIG. 2 . The relative frequency of the bases determines the relative heights of the letters, and since A is more frequent, it is placed on top. A position in which all four bases are equally likely is not conserved and so has an R sequence  of zero and its height on the logo is zero. When the frequencies of the bases are other than 0, 50 or 100 percent, the heights still measure the conservation at each position, and the calculation may be performed according to Equation I. 
     Example 3 
     Design of Primers 
     In order to perform a PCR, two segments of DNA (which are referred to as primers) may be designed and prepared. The two PCR primers represent a set of oligomers in which set the frequency of a nucleotide is proportional to its presence at this particular position in the sequence logo prepared based on a number of 16S rDNA sequences from different organisms. The primers were designed according to the following three criteria: (1) They are in regions of high conservation, and surround regions of low conservation. (2) The 3′ termini cover regions that are invariant between species, so that the primer end which is extended by the DNA polymerase is always properly annealed to the DNA. (3) The oligonucleotide primers are not self complementary and do not base pair to each other. The primers may also contain restriction sites useful for subsequent cloning of the amplification product. 
     The following primers have been designed based on the Logo prepared in Example 2, and the relative positions of Primer Set A is shown in  FIG. 2 : 
     Primer Set A: 
     
       
         
           
               
               
            
               
                 Forward: 
                   
               
               
                 (SEQ ID. NO. 1) 
                   
               
               
                 5′-G T G (C 0.988 /G 0.006 /T 0.006 ) CAGC (A 0.95 /C 0.038 /G 0.006 /T 0.006 ) G (C 0.994 /T 0.006 ) 
                   
               
               
                   
               
               
                 (A 0.006 /C 0.982 /G 0.006 /T 0.006 ) (C 0.006 /G 0.988 /T 0.006 ) (C 0.994 /T 0.006 ) G G T-3′ 
               
               
                   
               
               
                 Reverse: 
               
               
                 (SEQ ID. NO. 2) 
                   
               
               
                 5′-C C (C 0.994 /A 0.006 ) (T 0.006 /G 0.988 /A 0.006 ) (T 0.939 /C 0.055 /A 0.006 ) C (T 0.041 /A 0.959 ) A T 
                   
               
               
                   
               
               
                 (T 0.988 /C 0.006 /A 0.006 ) (T 0.033 /C 0.961 /A 0.006 ) (T 0.006 /G 0.006 /C 0.853 /A 0.135 ) (T 0.994 /C 0.006 ) T 
               
               
                   
               
               
                 (T 0.994 /G 0.006 ) (G 0.922 /A 0.072 /C 0.006 ) (A 0.994 /G 0.006 ) (G 0.994 /C 0.006 ) T (T 0.994 /A 0.006 ) 
               
               
                   
               
               
                 (T 0.994 /G 0.006 )-3′ 
               
            
           
         
       
     
     wherein the subscripts represent the relative abundance of the corresponding nucleotide at that position in the sequence as determined by information analysis of a large number of multiply-aligned sequences from a wide variety of prokaryotic species. 
     Primer Set B: 
     
       
         
           
               
               
            
               
                 Forward: 
                   
               
               
                 (SEQ ID. NO. 3) 
                   
               
               
                 5′-G 0.954 /T 0.043 /A 0.002 /C 0.001 ) (G 0.978 /C 0.02 /T 0.002 ) (T 0.9985 /G 0.0015 ) (T 0.992 /C 0.006 /A 0.002 ) 
                   
               
               
                   
               
               
                 (A 0.989 /C 0.004 /T 0.007 ) (A 0.998 /T 0.002 ) (G 0.998 /A 0.002 ) (G 0.003 /C 0.001 /T 0.996 ) (C 0.975 /G 0.021 /T 0.004 ) 
               
               
                   
               
               
                 (C 0.952 /A 0.042 /T 0.005 /G 0.001 ) (A 0.009 /C 0.882 /G 0.063 /T 0.046 ) (A 0.052 /C 0.002 /G 0.943 /T 0.003 ) 
               
               
                   
               
               
                 (A 0.005 /C 0.890 /G 0.003 /T 0.102 ) A A C G A-3′ 
               
               
                   
               
               
                 Reverse: 
               
               
                 (SEQ ID. NO. 4) 
                   
               
               
                 5′-C A (T 0.996 /C 0.002 /A 0.002 ) (T 0.996 /G 0.002 /A 0.002 ) G (C 0.005 /T 0.995 ) A (T 0.062 /G 0.914 /A 0.024 ) 
                   
               
               
                   
               
               
                 (T 0.074 /G 0.039 /C 0.887 ) (T 0.004 /G 0.008 /C 0.043 /A 0.945 ) (T 0.097 /C 0.903 ) G (T 0.911 /C 0.088 /A 0.001 ) 
               
               
                   
               
               
                 (G 0.982 /T 0.018 ) T (G 0.998 /C 0.002 ) (T 0.834 /C 0.036 /A 0.130 ) (A 0.032 /C 0.029 /G 0.057 /T 0.882 ) C C C-3′ 
               
            
           
         
       
     
     wherein the subscripts represent the relative abundance of the corresponding nucleotide at that position in the sequence as determined by information analysis of a large number of multiply-aligned sequences from a wide variety of prokaryotic species. 
     Primer Set C: 
     
       
         
           
               
               
            
               
                 Forward: 
                   
               
               
                 (SEQ ID. NO. 5) 
                   
               
               
                 5′-(G 0.954 /T 0.043 /A 0.002 /C 0.001 ) (G 0.978 /C 0.02 /T 0.002 ) (T 0.9985 /G 0.0015 ) (T 0.992 /C 0.006 /A 0.002 ) 
                   
               
               
                   
               
               
                 (A 0.989 /C 0.004 /T 0.007 ) (A 0.998 /T 0.002 ) (G 0.998 /A 0.002 ) (G 0.003 /C 0.001 / 0.996 ) (C 0.975 /G 0.021 /T 0.004 ) 
               
               
                   
               
               
                 (C 0.952 /A 0.042 /T 0.005 /G 0.001 ) (A 0.009 /C 0.882 /G 0.063 /T 0.046 ) (A 0.052 /C 0.002 /G 0.943 /T 0.003 ) 
               
               
                   
               
               
                 (A 0.005 /C 0.890 /G 0.003 /T 0.102 ) A A C G A-3′ 
               
               
                   
               
               
                 Reverse: 
               
               
                 (SEQ ID. NO. 6) 
                   
               
               
                 5′-(T 0.996 /A 0.002 /G 0.002 ) (C 0.994 /G 0.001 /T 0.005 ) (T 0.993 /C 0.005 /G 0.002 ) (G 0.995 /C 0.001 /A 0.004 ) 
                   
               
               
                   
               
               
                 (A 0.996 /T 0.0025 /C 0.0015 ) (C 0.997 /A 0.0015 /G 0.0015 ) G (G 0.998 /A 0.002 ) (G 0.996 /C 0.004 ) (C 0.998 /G 0.002 ) 
               
               
                   
               
               
                 (G 0.971 /A 0.027 /C 0.002 ) G T (G 0.999 /T 0.001 ) (T 0.953 /A 0.047 ) G T (A 0.946 /G 0.054 ) C A-3′ 
               
            
           
         
       
     
     wherein the subscripts represent the relative abundance of the corresponding nucleotide at that position in the sequence as determined by information analysis of a large number of multiply-aligned sequences from a wide variety of prokaryotic species. 
     Primer sets A, B or C may be used separately to amplify the 16S rDNA sequences of a prokaryotic organism. 
     Example 4 
     PCR Reactions 
     Materials 
     PCR reagents—see table below 
     Clinical sample dilutions, or purified samples (−20° C.) 
     Purified  E. coli  and human DNA (100 ng/μl) 
     1.5 or 2.0 ml centrifuge tubes 
     0.2 ml strip tubes or thin-wall thermocycler plates 
     pipettes and sterile pipette tips (1000 μl, 200 μl, 20 μl, 10 μl) 
     Preparation of Reaction Components 
     Obtain reagents from the freezer and place on ice. (ensure that all reagents are completely thawed and well mixed prior to use) 
     Calculate amount of each reagent needed based on following table [use number of sample dilutions and controls to be amplified +2 (for pipette error)] 
     Mix PCR cocktail in 1.5 or 2.0 ml sterile centrifuge tube. 
     
       
         
           
               
             
               
                 TABLE 2 
               
             
            
               
                   
               
               
                 Cocktail for Preparation of the PCR Reaction 
               
            
           
           
               
               
               
            
               
                 PCR Cocktail 
                 μl/reaction 
                 Final Concentration 
               
               
                   
               
            
           
           
               
               
               
            
               
                 RNase-free, DNase-free Water 
                 30.58 
                 na 
               
               
                 Room temp. 
               
            
           
           
               
               
               
               
            
               
                 1.25 mM dNTP −20° C. 
                 7.9 
                 200 
                 μM 
               
               
                 25 mM MgCl 2  −20° C. 
                 4 
                 2.0 
                 mM 
               
               
                 10 X PCR Buffer (Mg free) −20° C. 
                 5 
                 1 
                 X 
               
               
                 50 μM primer 931949* 
                 0.6 
                 0.6 
                 μM 
               
               
                 (forward) −20° C. 
               
               
                 50 μM primer 14621439* 
                 0.6 
                 0.6 
                 μM 
               
               
                 (reverse) −20° C. 
               
            
           
           
               
               
               
            
               
                 100% formamide 4° C. 
                 0.875 
                 1.75% 
               
            
           
           
               
               
               
               
            
               
                 20 mg/ml BSA −20° C. 
                 0.245 
                 0.098 
                 mg/ml 
               
            
           
           
               
               
               
            
               
                 5 U/ul Taq Polymerase** −20° C. 
                 0.2 
                 1 U/50 ul reaction 
               
               
                   
               
               
                 *one primer may be biotinylated if magnetic separation of PCR product is going to be used, this labeled primer is preferably diluted 1:5 (1 part primer, 4 parts water). 
               
               
                 **Taq Polymerase should be kept at −20° C. until just before PCR is performed (add last) 
               
            
           
         
       
     
     With each PCR amplification reaction, run two positive controls and one negative control: 
     Positive Controls:
         50 μl PCR cocktail, 2 μl control DNA (stored at −20° C., 100 ng/μl)   prepare 1  E. coli  DNA and 1 human genomic DNA       

     Negative Control:
         −50 μl PCR cocktail   Add 50 μl of PCR cocktail to 0.2 ml PCR strip tubes or plate at 4° C. (one for each sample dilution and control)   Add 2.5 μl of clinical sample (see sample prep) or 2.0 μl of purified sample (controls or purified DNA samples)   Run Omniper program on MJ Alpha thermocycler       

     OmniPCR Program (2 hr. 20 min.) 
     
       
         
           
               
               
               
               
             
               
                   
               
               
                 Cycle 
                 Temperature 
                 Time 
               
               
                   
               
             
            
               
                   
               
            
           
           
               
               
               
               
            
               
                 1 
                 95° C. 
                 2 
                 min. 
               
               
                 2 
                 95° C. 
                 30 
                 sec. 
               
               
                 3 
                 50° C. 
                 45 
                 sec. 
               
               
                 4 
                 72° C. 
                 45 
                 sec. 
               
            
           
           
               
               
               
            
               
                 5 
                 35 times to cycle 2 → 3 → 4 
                   
               
            
           
           
               
               
               
               
            
               
                 6 
                 72° C. 
                 10 
                 min. 
               
            
           
           
               
               
               
            
               
                 7 
                  4° C. 
                 hold 
               
               
                   
               
            
           
         
       
     
     Store at 4° C. after PCR is complete. 
     Run results on a 2% LE agarose gel to determine which samples amplified bacterial DNA (see agarose gel procedure) 
     Example 5 
     Agarose Gel Detection of PCR Products 
     Materials: 
     
         
         10-15 μl PCR product 
         3× loading buffer 
         123 bp ladder (optional) 
         Fisher, Molecular Biology Grade Agarose 
         Gel box and combs 
         P20 pipette and tips 
         Ethidium Bromide 
         Microwave oven 
         0.5×TBE buffer 
         Erlenmeyer flask for making gel 
         Graduated cylinder
 
Detailed Protocols:
 
       
    
     Prepare gel box for pouring gel 
     Prepare a 2% agarose gel (add 2 grams/100 ml agarose to 0.5×TBE) 
     Microwave on high power for 2 min. Stop every 10-15 seconds and swirl until all agarose has dissolved. 
     Allow to cool slowly by placing at 55° C. for 10 minutes 
     Add 3 μl 1% Ethidium Bromide solution and carefully swirl to mix in EtBr (do not swirl too vigorously or air bubbles will be produced). EtBr is a CARCINOGEN—WEAR GLOVES. 
     Pour gel into tray, place comb in appropriate position and allow gel to solidify 
     Remove rubber end pieces carefully. Fill gel box with 0.5×TBE until gel is just submerged. Carefully remove comb while submerged. 
     Cut off a piece of parafilm and pipette 3 ul of 3× loading buffer onto the parafilm for each sample and ladder. 
     Add 3 ul of ladder solutions (optional) to loading buffer (one on each end). Add 10-15 ul of 0.5×TBE buffer to these. 
     Add 10-15 ul of 0.5×TBE to ladder solutions 
     Add 10-15 ul PCR product to remaining loading buffer. 
     Load samples onto gel and run between 100-125 V for 30-45 min. at room temperature. 
     Place gel on UV light box to visualize. 
     Photograph gel for documentation. 
     Bacterial bands can be visualized by corresponding band location on the samples to that of the  E. coli  control and DNA ladder. 
     Be sure to note any contamination in the negative control which may also indicate contamination in the other samples. 
     Typical results of the PCR amplification reaction for a wide variety of infectious agents are shown in  FIG. 5 . 
     Example 6 
     Cycle Sequencing of the PCR Products 
     Materials 
     Magnetically separated PCR products or Gel purified PCR product 
     Visible Genetics 7-deaza*Thermosequenase cycle sequencing kit (Cat# US79608): 
     A, C, G, T termination mixes (7-deaza G) 
     Thermo Sequenase enzyme 
     Enzyme dilution buffer 
     Sequencing Buffer I 
     Cy5.5 or Cy5.0 labeled sequencing primer (3 μM) 
     0.2 mL thin walled tubes (4 tubes per sample) 7-deaza G termination mixes reduce the formation of secondary structures in the target DNA which cause poor sequencing results. 
     Preparation of Reaction Components 
     Remove all reagents from freezer and thaw on ice. Mix well before use. 
     Label four tubes for each PCR product: A, C, G, T. Aliquot 3 μL of each of the A, C, G, and T termination mixes into their labeled tubes respectively at 4° C. 
     Make an aliquot of 1:10 diluted Thermo Sequenase enzyme (9 parts enzyme dilution buffer: 1 part Thermo Sequenase enzyme). Place on ice. 
     Add the following to 14 μl of the magnetically separated or gel purified PCR products:
         2.5 μl Sequencing Buffer I   2.5 μl Cy5.5 of Cy5.0 labeled nested primer (3 μM)   3.0 ∥l diluted (1:10) Thermo Sequenase enzyme mix well       

     Aliquot 5 μl of the above mix into each of the termination tubes. Mix well by pipetting up and down. 
     Place tubes in thermocycler and run cycle sequencing program (CYCLMOD2 or CYCLE2 on PTC-200) 
     One Step Cycle Sequencing: 
     CYCLEMOD2 program: (1 hr. 30 min.) 
     
       
         
           
               
               
               
               
             
               
                   
               
               
                 Stage 
                 Temp. 
                 Time 
                 #cycles 
               
               
                   
               
             
            
               
                   
               
            
           
           
               
               
               
               
               
               
            
               
                 1) 
                 Denaturation 
                 94° C. 
                 2 
                 min 
                 1 
               
               
                 2) 
                 Cycle 
                 94° C. 
                 40 
                 sec 
                 25* 
               
               
                   
                   
                 50° C. 
                 20 
                 sec 
               
               
                   
                   
                 72° C. 
                 60 
                 sec 
               
               
                 3) 
                 Final extension 
                 72° C. 
                 2 
                 min 
                 1 
               
            
           
           
               
               
               
               
               
            
               
                 4) 
                 Soaking 
                  4° C. 
                 infinity 
               
               
                   
               
               
                 *At Step 2, during each cycle, the samples are subject to three different temperatures sequentially for the indicated time period, and this 3-step cycle is repeated 25 times. 
               
            
           
         
       
     
     Two Step Cycle Sequencing: 
     (may help reduce hard stops due to secondary structures) 
     CYCLE2 program: (1 hr. 30 min.) 
     
       
         
           
               
               
               
               
             
               
                   
               
               
                 Stage 
                 Temp. 
                 Time 
                 #cycles 
               
               
                   
               
             
            
               
                   
               
            
           
           
               
               
               
               
               
               
            
               
                 1) 
                 Denaturation 
                 94° C. 
                 2 
                 min 
                 1 
               
               
                 2) 
                 Denaturation 
                 94° C. 
                 20 
                 sec 
                 20* 
               
               
                   
                 Annealing 
                 50° C. 
                 20 
                 sec 
               
               
                   
                 Extension 
                 72° C. 
                 60 
                 sec 
               
               
                 3) 
                 Denaturation 
                 94° C. 
                 20 
                 sec 
                  20** 
               
               
                   
                 Extension 
                 72° C. 
                 60 
                 sec 
               
               
                 4) 
                 Final extension 
                 72° C. 
                 2 
                 min 
                 1 
               
            
           
           
               
               
               
               
               
            
               
                 5) 
                 Soaking 
                  4° C. 
                 -infinity 
               
               
                   
               
               
                 *At Step 2, during each cycle, the samples are subject to three different temperatures sequentially for the indicated time period, and this 3-step cycle is repeated 20 times. 
               
               
                 **At Step 3, during each cycle, the samples are subject to two different temperatures sequentially for the indicated time period, and this 2-step cycle is repeated 20 times. 
               
            
           
         
       
     
     Samples are now ready for automated DNA sequencing. 
     Example 7 
     CGDE to Identify Multiple Organisms in the Same Sample 
     The percent denaturant can be varied to maximize the separation of the DNA on the gel. Currently gels containing 30% denaturant are run. Using the temperature controlled, Owl vertical gel electrophoresis unit (Owl Scientific), 75-80 ml of appropriate percentage gel to cast one CGDE. For this example 30% denaturant will be used. Mix 52.5 ml of 0% denaturant, 22.5 ml of 100% denaturant and 323 μl of 20% APS in a vacuum flask. Remove the air by placing under vacuum for several minutes. After the air is removed add 138 μl of TEMED. Swirl gently and add the gel mixture to the glass plates. 
     Preparation of the Gel Apparatus and Peristaltic Heating Unit: 
     The circulating heater bath to control gel box temperature must be turned on- and running through the gel box at 60 C. The plates used for CDGE need to be cleaned with soap and water and also with 95-100% ethanol. Plastic spacers are placed between the plates to separate multiple gels. The plates are then placed inside a plastic freezer bag. Cut the top of the freezer bag off so it is approximately the same height as the glass plates, this allows for easier pouring of the gel. Once this is done place the bag/plate sandwich in the Joey gel casting system (Owl Scientific) and tighten the screws down. Place the comb between the plates making sure that the wells are only about 5 mm below the top of the glass plates. If the wells are too deep, the samples will disperse during loading, resulting in pour resolution. This setup should be performed before the acrylamide is degassed prior to pouring the gels. 
     Casting the Gel: 
     Once the gel casting system is assembled and the gel is ready to pour you will need to get a 1000 μl pipet tip and the 60 CC syringe. Cut about 3 mm off the end of the pipet tip with a scalpel and attach to the syringe. Pour the gel from the vacuum flask into an appropriately sized beaker (so you can fit the syringe into the gel). Suck up the gel with the syringe and add between the glass plates. The space between the plates filling with the gel should be visible. Fill the plates to the top with the gel. Once the gel is poured, wait 15-30 min. until it has polymerized. 
     Final Gel Preparation: 
     After the gel has polymerized remove it from the gel casting system and the plastic bag. Scrape any excess polyacrylamide from the outside of the plates. Wiping the plates with a damp paper towel after scraping the excess off helps remove any residual polyacrylamide. Place the plate/gel sandwich in the vertical gel box that has the 60 degree water running through it (you should have turned the heater for the water on earlier—make sure to check the volume of water in the heater). Place 1×TBE buffer in the bottom of the gel box and between the gel and the vertical part of the box. Unless two gels are being run, the other side of the gel box should have a plastic plate in it so the buffer can fill the vertical part of the chamber and cover the platinum wire that generates the current. Remove the comb and straighten the polyacrylamide between the gels for easier loading. The gel can now be loaded. 
     Sample Preparation, Loading and Electrophoresis: 
     The samples used for CDGE should come from 100 ul PCR reactions so there is enough DNA to detect by CDGE. Make sure to do an agarose gel check to verify that sufficient amplification product is available before running the sample on a CDGE. If there is ample DNA add 20-25 μl of CDGE loading dye (contains 50% formamide) to the sample, place in thermocycler and run CDGE3 program. Once the program is finished, add ˜20 μl of sample to the wells and run the gel. The gel is run at 60 mA for 4-4.5 hours. Once the gel is done running remove it from the gel box and remove one of the glass plates. Make sure you mark the gel so you know the orientation. Remove the plastic spacers and plate the plate with the gel inside a plastic bag and in one of the gel dying trays. 
     Staining the Gel and Photographic Exposure: 
     Once the gel is in the bag in the dying tray add 300 ml of dye (Gelstar SYBER Green—2×). Placing the gel in the bag allows more of the dye to get on the gel (you can fold the bag up to move more dye onto the gel). Cover the gel/gel tray with aluminum foil and stain gel for 30 minutes. After the gel is stained, remove it from the bag and place on seran wrap (the stain can be dumped from the bag and saved-dye is good for several days if kept in fridge and covered). Use the seran wrap to cover the gel and flip it so the gel can be removed from the glass plate. Once the plate is removed place the gel on the UV-light box and look at it. Photograph the gel with the electronic digital camera and cut out bands and elute the DNA for DNA sequencing. 
     Example 8 
     Obtaining and Editing Sequencing Results 
     Editing an Automatically Aligned and Base Called Electropherogram: 
     Click on the sample to be edited to bring up the curve viewer of sequence data for that sample. Smaller regions of the electropherogram can be viewed and edited by shortening and moving the zoombox above the sequence data. 
     First view the signal strength of the region between the primer peak and the end of sequence peak (this is the region of our target DNA sequence). The peak heights should be at least 1,000 as indicated on the left of the sequence under the viewing options. If signal strength is too weak, clean sequence data cannot be achieved. Also, if the peak heights of the sequence data are too high (above the threshold of the software), the peaks will flatten on the top and clean sequence data cannot be achieved. Optimal peak height is approx. 1,000 to 4,000, however, it may be possible to achieve clean sequence outside this range. 
     If the electropherogram has been automatically aligned and base called, check the run overview. The less black and grey sections on the bottom portion of the run overview, the better the sequence quality. 
     Scroll through the sequence to visually check the accuracy of the automated alignment and base calling. If the electropherogram appears to be aligned and base called accurately, continue with the procedure below. If not, the electropherogram may need to be manually aligned and/or base called (see section below “Manually aligning and base calling and electropherogram”). 
     OPTION: Under TOOLS, BASE CALLING, ATTRIBUTES, the heterozygote stringency can be changed to achieve more accurate sequence results. PURE (˜50%) has proven to work well in the past. If you change the heterozygotes function, re-base call the sequence by selecting BASECALL under MANUAL and click on GO. 
     Start from the primer peak region and scroll through slowly. Make any adjustments to the electropherogram that are necessary (the software will occasionally miscall bases). Add a base by clicking on the location the base belongs and typing the appropriate letter. Delete a base or bases by highlighting the region containing the base/bases to be deleted and pressing the backspace button. If a region of the electropherogram is unclear as to what the sequence should be, insert an appropriate amount of n&#39;s in this region. 
     Make sure to delete the bases called, if any, in the primer peak region, end of sequence peak region, and any other region of the electropherogram not containing the target DNA sequence. It may also be necessary to delete up to the first 20 bases past the primer peak and before the end of sequence peak if these regions of the electropherogram are poorly aligned and/or base called. Try to keep as much sequence data as possible while maintaining a high degree of accuracy. 
     Save the electropherogram. This file is now ready for sequence analysis. 
     Manually Aligning and Base Calling an Electropherogram: 
     If the electropherogram is aligned well but not base called, manually base call the electropherogram by clicking on each peak and typing the appropriate base. Insert Ns where the sequence is unclear. 
     If the electropherogram is poorly aligned:
     1) Check the quality of sequence data by scrolling through the electropherogram. The tiled function under the viewing options in the curve viewer can be selected to view each lane separately. If the background noise is high or if the peaks on the electropherogram are not clear and distinct from each other, then clean sequence data cannot be achieved from this electropherogram. If the peaks for each lane appear clean and distinct from each other with low background noise, then continue to step 2 below.   2) You can try adjusting the peak distance (under TOOLS, BASE CALLING, ATTRIBUTES). The software attempts to automatically align the electropherogram at a default setting of 8.00 for peak distance. The actual peak distance will be most likely be somewhere between 5 and 8. You can attempt to adjust the peak distance and select ALIGN, under MANUAL and click on GO to re-align the electropherogram. By trial and error, this may produce an accurate alignment. If not, continue to step 3 below.   3) Manually align the sequence:
       Under MANUAL, click on RESET TO RAW   Start at end of sequence peak. Under ALIGN POINTS, ADD and align point to the end of sequence peak. Click on SHOW under ALIGN POINTS. Click on the align point you just added.   Adjust the four lanes using the arrows under manual alignment until the end of sequence peak is aligned in all four lanes.   Add another align point about 20 nucleotides before the end of sequence peak, click on it.   Adjust the four lanes (in the same manner as before) until they are aligned between the two align points.   Add another align point about 20 nucleotides before the last one and align the lanes as above. Continue this until the entire sequence is aligned.   
       

     Manual alignment takes practice and requires trial and error. A user may need to start at a different place in the electropherogram or use different methods from those listed above. Even if peaks for each lane on the electropherogram appear clean and distinct with low background noise, alignment may be impossible due to a multiple infection creating peaks in more than one lane in the same location. 
     If alignment of the electropherogram is achieved, the electropherogram may or may not be able to be automatically base called. To attempt automatic base calling, select BASECALL under MANUAL and click on GO. 
     If the sequence doesn&#39;t base call, manually base call by clicking on each peak and typing the appropriate letter. 
     If a sequence is achieved, save the electropherogram. This file is now ready for sequence analysis. 
     Example 9 
     Sequence Analysis 
     After a “clean” assay sequence is achieved, it is then assembled into a contig by comparison with other “clean” overlapping and complementary sequences from the same specimen, and the consensus sequence is derived from the contig sequence. The sequence analysis containing this sequence is performed to identify the organism based on the rDNA sequence. The consensus sequence (or the assay sequence) is then compared to a database of approx. 11,400 prokaryotic 16S rDNA sequences. A quick sequence analysis can be performed by running atblast (a software script which compares the test sequence with this database using the NCBI Blast engine) on the Sun 5 scientific workstation. Atblast will display the best 50 matches and pairwise alignments from a blast search comparing our sequence with the sequence database. An, in depth, comprehensive analysis can be performed by running atblasttest on the Sun workstation. This program will perform a Blast search as in atblast, followed by a multiple sequence analysis to relates the consensus or assay sequences to the most closely related organisms demonstrated by the Blast search, and then computes and displays two different types of phylogenetic trees based on the relationships between these closely related, multiply-aligned sequences (Parsimony and Neighbor-joining trees). Atblasttest will save all of the relevant files for each analysis under a time-date stamped folder for each assay or consensus sequence file entered. 
     Running the Atblast Script 
     On the Sun workstation, open a terminal window and enter atblast at the prompt. 
     On the Visible Genetics&#39; computer, make sure ShiptoSun folder (Users&gt; Lab&gt; Data&gt; LAB&gt; ShiptoSun) contains no assay files. The ShiptoSun script looks at this folder and exports the results of the sequence analysis to the Sun workstation where the atblast analysis commences. If it does, move these files back to the appropriate folders. 
     Place the assay file containing the sequence to be analyzed in the ShiptoSun folder. 
     Open the terminal shell on the Visible Genetics computer. 
     At the visgen1&gt; prompt, type ftpSun 
     Within 20 seconds, the output from the atblast file will be displayed on the Sun workstation. 
     Compare the atblast results with the electropherogram for the assay file you just sent to the Sun workstation. Look for differences between the reference sequence and your sequence in the atblast output. Check the locations of these differences on the electropherogram on the Visible Genetics computer and make any changes that are necessary. NOTE: Only make changes on the electropherogram in locations where the sequence is clearly incorrect. 
     If changes are made to the assay file based on the atblast results, save the assay file. NOTE: The assay file will be saved in its original location and not in the ShiptoSun folder, so if the updated assay file is to be sent back to the Sun workstation for further analysis, it must be put into the ShiptoSun folder from its original location. 
     Record any pertinent information from the atblast file (species of closely matching sequences, # nucleotides, % match, etc.) 
     Atblast analysis may be sufficient for some applications. If the assay file being sent contains a new clinical specimen sequence, atblasttest should be performed for a complete sequence analysis. 
     Running the Atblasttest Script: 
     Set up atblasttest exactly as atblast above (except for the different program name entered into the Sun workstation) 
     Output for atblasttest takes approx. 30 min. 
     After atblasttest is finished running, five windows will be displayed:
         1) The terminal window—describing the program&#39;s processes that were performed   2) Primary sequence analysis report—basic blast search   3) Clustal X—a color coded multiple sequence analysis   4) Treetool: newseqtree.ph—a phylogenetic tree analysis   5) newseqtree.ph—a different phylogenetic tree analysis       

     Compare the multiple sequence alignment to your original electropherogram. Look for positions where differences occur in the sequences shown in the multiple sequence alignment. Compare these positions to you sample&#39;s sequence and electropherogram. Make any changes to your sample&#39;s electropherogram that seem apparent. If any changes are made, perform atblasttest again. 
     Observe the phylogenetic tree files to see the phylogenetic relationship between your sample sequence and closely related sample sequences. The two tree files created may show a different phylogenetic relationship because of different tree forming algorithms used in each. 
     To close and save the windows generated by atblasttest (must be done before another atblasttest analysis is performed):
         1) Under the ClustalX window, write the alignment as postscript (under FILE), then quit (under FILE). A postscript multiple sequence analysis will then be shown, this can be printed or closed.   2) Under the Treetool: newseqtree.ph window, under FILE with the right mouse button, select quit.   3) Under the newseqtree.ph window, click on SAVE TREE, then close.   4) Under the Preliminary Sequence Analysis Report, close window.       

     The terminal window will indicate the filename under which the atblasttest files for that sample sequence are located. 
     Example 10 
     Feasibility Study 
     In order to determine whether the primers and the methods of the present disclosure work across a broad spectrum of species, purified organisms were obtained and cultured in a laboratory setting. Genomic DNAs were extracted from these cultured organisms and used as template for PCR using Primer sets A, B and C. The results of the PCR reactions are summarized in Tables 3 and 4. The PCR products shown in Table 4 were also subject to sequencing using primer A which results are shown in the same Table. 
     
       
         
           
               
             
               
                 TABLE 3 
               
             
            
               
                   
               
               
                 Feasibility Test Using Purified Organisms 
               
            
           
           
               
               
               
               
            
               
                   
                 931/949 
                 1819/1839 
                 1819/1839 
               
               
                   
                 1462/1439 
                 2391/2370 
                 2599/2578 
               
               
                   
                   
               
            
           
           
               
               
               
               
            
               
                 
                   Acinetobacter 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Actinobacillus 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Actinomyces pyogenes 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Actinomyces pyogenes 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Aeromonas hydophilia 
                 
                 + 
                 + 
               
               
                 
                   Alcaligenes fecalis 
                 
                 + 
                   
                 + 
               
               
                 
                   Aligella urethralis 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Alteromonas putriaciens 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Alteromonas putrifuciens 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Bacteriodes distasonis 
                 
                 + 
               
               
                 
                   Bacteriodes fragila 
                 
                 + 
               
               
                 
                   Bacteriodes melaninogenicus 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Bacteriodes ovatus 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Bacteriodes thetaiomicion 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Bacteriodes uniformis 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Campylobacter 
                 
                 + 
                 + 
               
               
                 
                   Candida albicans 
                 
                 + 
               
               
                 
                   Capnocytophaga 
                 
                 + 
                 nd 
                 nd 
               
               
                 CDC group IVc 
                 + 
                 nd 
                 nd 
               
               
                 
                   Chlamydia trachomatis 
                 
                 + 
               
               
                 
                   Citrobacter fruendii 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Clostridium difficle 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Clostridium histolyticum 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Clostridium perfingens 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Clostridium septicum 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Clostridium sordelli 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Clostridium sporogenes 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Corynebacterium diptheria 
                 
                 + 
               
               
                 
                   Corynebacterium pseudodoi. 
                 
                 + 
               
               
                 
                   E. coli 
                 
                 + 
                 + 
                 + 
               
               
                   E. coli  0157-H7 
                 + 
                 nd 
                 nd 
               
               
                   E. coli - β lactamase positive 
                 + 
                 nd 
                 nd 
               
               
                 
                   Enterobacter aerogenes 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Enterobacter cloecae 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Enterobacter fecalis 
                 
                 + 
               
               
                 
                   Eubacterium lentum 
                 
                 + 
               
               
                 
                   Flavobacterium 
                 
                 + 
                 + 
                 + 
               
               
                 
                   meningiosepticum 
                 
               
               
                 
                   Fusobacterium 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Fusobacterium miningio 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Haemophilia parainfluenza 
                 
                 + 
                 + 
               
               
                 
                   Haemophilis influenza 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Haemophilus aphrophilus 
                 
                 + 
                 nd 
                 nd 
               
               
                 
                   Klebsiella oxytoca 
                 
                 + 
                 nd 
                 nd 
               
               
                 
                   Klebsiella pneumonia 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Klebsiella rhinoscleromatis 
                 
                 + 
                 nd 
                 nd 
               
               
                 
                   Legionella micdliea 
                 
                 + 
               
               
                 
                   Legionella pneumophilia 
                 
                 + 
                 + 
               
               
                 
                   Leuconostoc lactic 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Leuconostoc mesanteriodas 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Listeria murrayi 
                 
                 + 
                 nd 
                 nd 
               
               
                 
                   Mima 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Mycobacterium avium 
                 
                 + 
               
               
                 intracellulari 
               
               
                 
                   Mycobacterium flavescens 
                 
                 + 
                 + 
               
               
                 
                   Mycobacterium gordoniae 
                 
                 + 
               
               
                   Mycobacterium terra  group 
                 + 
                 + 
               
               
                 
                   Mycobacterium tuberculoses 
                 
                 + 
               
               
                 
                   Neisseria cinerea 
                 
                 + 
                 nd 
                 nd 
               
               
                 
                   Neisseria gonorrhea 
                 
                 + 
               
               
                 
                   Neisseria lactamica 
                 
                 + 
               
               
                 
                   Neisseria meningiditis 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Neisseria sicca 
                 
                 + 
               
               
                 
                   Nocardia brasiliensis 
                 
                 + 
                 nd 
                 nd 
               
               
                 
                   Pasteurella multocida 
                 
                 + 
                 nd 
                 nd 
               
               
                 
                   Proteus mirabilis 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Proteus vulgaris 
                 
                 + 
                 + 
                 + 
               
               
                   Pseudomonas cepatia  (strain I) 
                 + 
                   
                 + 
               
               
                   Pseudomonas cepatia  (strain II) 
                 + 
                 + 
                 + 
               
               
                 
                   Salmonella cholerasuis 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Salmonella dublin 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Salmonella muenchen 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Salmonella paratyphi 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Salmonella typhimurium 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Serratia oderifera 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Shigella boydii 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Shigella dysenteriae 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Shigella felxneri 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Shigella sonneri 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Staphylococcus aureus 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Staphylococcus epi. 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Staphylococcus saphrophy. 
                 
                 + 
                 + 
                 + 
               
               
                   Streptococcus  alpha 
                 + 
                 + 
               
               
                   Streptococcus  beta (Group C) 
                 + 
                 nd 
                 nd 
               
               
                   Streptococcus  beta (Group F) 
                 + 
                 nd 
                 nd 
               
               
                 
                   Streptococcus bovis 
                 
                 + 
                   
                 + 
               
               
                 
                   Streptococcus fecalis 
                 
                 + 
                 + 
                 + 
               
               
                   Streptococcus  Group B 
                 + 
                 + 
                 + 
               
               
                 
                   Streptococcus mitis 
                 
                 + 
                 nd 
                 nd 
               
               
                 
                   Streptococcus mutans 
                 
                 + 
                 + 
               
               
                 
                   Streptococcus pneumonia 
                 
                 + 
                 + 
               
               
                 
                   Torulopsis globrata 
                 
                 + 
               
               
                 
                   Treponema denticola 
                 
                 + 
                 nd 
                 nd 
               
               
                 
                   Treponema pallidum 
                 
                 + 
                 nd 
                 nd 
               
               
                 
                   Treponema pertenue 
                 
                 + 
                 nd 
                 nd 
               
               
                 
                   Treponema phagedenis 
                 
                 + 
                 nd 
                 nd 
               
               
                 
                   Treponema refrigens 
                 
                 + 
                 nd 
                 nd 
               
               
                 
                   Vibro paruhen 
                 
                 + 
                 + 
                 + 
               
               
                 
                   Yersinia enterolitica 
                 
                 + 
                 + 
                 + 
               
               
                   
               
            
           
         
       
     
     
       
         
           
               
             
               
                 TABLE 4 
               
             
            
               
                   
               
               
                 Feasibility: Purified Organisms Tested Using PCR and Sequencing 
               
            
           
           
               
               
               
            
               
                   
                 Amplified 
                 Sequenced 
               
            
           
           
               
               
               
            
               
                   
                 Primer pairs: 
                   
               
            
           
           
               
               
               
               
               
               
            
               
                   
                 Species 
                 A* 
                 B 
                 C 
                 A 
               
               
                   
                   
               
               
                   
                 Alpha  streptococcus   
                 + 
                 + 
                   
                 + 
               
               
                   
                 
                   Staphlococcus epi. 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Streptococcus fecalis 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Staphlococcus aureus 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                   E. Coli  (unknown type) 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                   Pseudomonas cepatia  (I) 
                 + 
                   
                 + 
                 + 
               
               
                   
                 
                   Acinetobacter 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Haemophilis influenza 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Enterobacter fecalis 
                 
                 + 
                   
                   
                 + 
               
               
                   
                 
                   Shigella sonneri 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Serratia oderifera 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Klebsiella pneumonia 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Proteus mirabilis 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Chlamydia trachomatis 
                 
                 + 
                   
                   
                 + 
               
               
                   
                 
                   Staphlococcus saphrophy. 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Candida albicans 
                 
                 + 
                   
                   
                 + 
               
               
                   
                 
                   Torulopsis globrata 
                 
                 + 
                   
                   
                 + 
               
               
                   
                 
                   Proteus vulgaris 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                   Pseudomonas cepatia  (II) 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Shigella dysenteriae 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Shigella felxneri 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Shigella boydii 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Salmonella muenchen 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Salmonella typhimurium 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Salmonella cholerasuis 
                 
                 + 
                 + 
                 + 
                 nd 
               
               
                   
                 
                   Salmonella dublin 
                 
                 + 
                 + 
                 + 
                 nd 
               
               
                   
                 
                   Salmonella paratyphi 
                 
                 + 
                 + 
                 + 
                 nd 
               
               
                   
                 
                   Aeromonas hydophila 
                 
                 + 
                   
                   
                 + 
               
               
                   
                 
                   Alteromonas putrifuciens 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Mima 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Alcaligenes fecalis 
                 
                 + 
                   
                 + 
                 + 
               
               
                   
                 
                   Enterobacter cloecae 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Enterobacter aerogenes 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Fusobacterium miningo 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Citrobacter fruendii 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Vibro paruhen 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Yersinia enterolitica 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Leuconostoc lactic 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Leuconostoc mesanteriodas 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Actinobacillus 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Actinomyces pyogenes 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Bacteriodes fragila 
                 
                 + 
                   
                   
                 + 
               
               
                   
                 
                   Bacteriodes distasonis 
                 
                 + 
                   
                   
                 + 
               
               
                   
                 
                   Bacteriodes melaninogenicus 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Bacteriodes ovatus 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Bacteriodes thetaiomicion 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Bacteriodes uniformis 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Clostridium difficile 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Clostridium histolyticum 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Clostridium perfingens 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Clostridium sordelli 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Clostridium septicum 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Clostridium sporogenes 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Eubacterium lentum 
                 
                 + 
                   
                   
                 + 
               
               
                   
                 
                   Fusobacterium 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Actinomyces pyogenes 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Corynebacterium pseudodoi. 
                 
                 + 
                   
                   
                 + 
               
               
                   
                 
                   Mycobacterium avium 
                 
                 + 
                   
                   
                 + 
               
               
                   
                 intracellulari 
               
               
                   
                 
                   Streptococcus pneumonia 
                 
                 + 
                 + 
                   
                 + 
               
               
                   
                   Streptococcus  Group B 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Mycobacterium tuberculosis 
                 
                 + 
                   
                   
                 + 
               
               
                   
                 
                   Neisseria lactamica 
                 
                 + 
                   
                   
                 + 
               
               
                   
                 
                   Streptococcus mutans 
                 
                 + 
                 + 
                   
                 + 
               
               
                   
                 
                   Aeromonas hydophilia 
                 
                 + 
                 + 
                   
                 + 
               
               
                   
                 
                   Neisseria meningiditis 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Alteromonas putriaciens 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Legionella micdliea 
                 
                 + 
                   
                   
                 + 
               
               
                   
                 
                   Haemophilia parainfluenza 
                 
                 + 
                 + 
                   
                 + 
               
               
                   
                 
                   Legionella pneumophilia 
                 
                 + 
                 + 
                   
                 + 
               
               
                   
                 
                   Corynebacterium diptheria 
                 
                 + 
                   
                   
                 + 
               
               
                   
                 
                   Campylobacter 
                 
                 + 
                 + 
                   
                 + 
               
               
                   
                 
                   Neisseria gonorrhea 
                 
                 + 
                   
                   
                 + 
               
               
                   
                 
                   Streptococcus bovis 
                 
                 + 
                   
                 + 
                 + 
               
               
                   
                 
                   Mycobacterium gordoniae 
                 
                 + 
                   
                   
                 + 
               
               
                   
                 
                   Neisseria sicca 
                 
                 + 
                   
                   
                 + 
               
               
                   
                 
                   Mycobacterium terra 
                 
                 + 
                 + 
                   
                 + 
               
               
                   
                 
                   Mycobacterium flavescens 
                 
                 + 
                 + 
                   
                 + 
               
               
                   
                 
                   Aligella urethralis 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   Flavobacterium 
                 
                 + 
                 + 
                 + 
                 + 
               
               
                   
                 
                   meningiosepticum 
                 
               
               
                   
                 
                   Treponema pallidum 
                 
                 + 
                 nd 
                 nd 
                 nd 
               
               
                   
                 
                   Treponema pertenue 
                 
                 + 
                 nd 
                 nd 
                 nd 
               
               
                   
                 
                   Treponema phagedenis 
                 
                 + 
                 nd 
                 nd 
                 nd 
               
               
                   
                 
                   Treponema denticola 
                 
                 + 
                 nd 
                 nd 
                 nd 
               
               
                   
                 
                   Treponema refrigens 
                 
                 + 
                 nd 
                 nd 
                 nd 
               
               
                   
                 Beta  streptococcus  (C) 
                 + 
                 nd 
                 nd 
                 nd 
               
               
                   
                 Beta  streptococcus  (F) 
                 + 
                 nd 
                 nd 
                 nd 
               
               
                   
                 
                   Listeria murrayi 
                 
                 + 
                 nd 
                 nd 
                 nd 
               
               
                   
                 
                   Nocardia brasiliensis 
                 
                 + 
                 nd 
                 nd 
                 nd 
               
               
                   
                 
                   Streptococcus mitis 
                 
                 + 
                 nd 
                 nd 
                 nd 
               
               
                   
                 
                   Haemophilus aphrophilus 
                 
                 + 
                 nd 
                 nd 
                 nd 
               
               
                   
                   E. coli - β lactamase+ 
                 + 
                 nd 
                 nd 
                 nd 
               
               
                   
                   E. coli  0157-H7 
                 + 
                 nd 
                 nd 
                 nd 
               
               
                   
                 
                   Klebsiella rhinoscleroma. 
                 
                 + 
                 nd 
                 nd 
                 nd 
               
               
                   
                 
                   Klebsiella oxytoca 
                 
                 + 
                 nd 
                 nd 
                 nd 
               
               
                   
                 
                   Capnocytophaga 
                 
                 + 
                 nd 
                 nd 
                 nd 
               
               
                   
                 
                   Pasteurella multocida 
                 
                 + 
                 nd 
                 nd 
                 nd 
               
               
                   
                 CDC group IVc 
                 + 
                 nd 
                 nd 
                 nd 
               
               
                   
                 
                   Neisseria cinerea 
                 
                 + 
                 nd 
                 nd 
                 nd 
               
               
                   
                   
               
               
                   
                 *Degenerate primers were synthesized from coordinates in the 16S rDNA sequence logo. Sequence confirmation was obtained with primer pair A. 
               
            
           
         
       
     
     Example 11 
     Retrospective Clinical Study 
     Clinical samples containing microorganisms that have been identified were processed and analyzed according to the procedure disclosed in Examples 1-9. The main results obtained using the presently disclosed methods and those obtained using conventional microbiological methods are compared as shown in Table 5. 
     
       
         
           
               
             
               
                 TABLE 5 
               
             
            
               
                   
               
               
                 Results of Retrospective Clinical Study 
               
            
           
           
               
               
               
               
               
               
               
               
               
            
               
                 Patient 
                 Phylo 
                   
                   
                   
                   
                 Phylogenetix ID 
                   
                 Date 
               
               
                 Hospital 
                 Reference 
                   
                   
                 (Amp. #) 
                 Experi- 
                 Based on Blast 
                 % Sequence 
                 Specimen 
               
               
                 No. 
                 No. 
                 Sample Type 
                 Hospital Identification 
                 Primers 
                 menter 
                 Analysis 
                 Identity 
                 Received 
               
               
                   
               
            
           
           
               
               
               
               
               
               
               
               
               
            
               
                 H53910 
                 13I 
                 MS Irrigation fluid 
                   S. aureus  - mod. 
                 (2)A 
                 M 
                 
                   Staph. aureus 
                 
                 98 
                 Jun. 13, 1997 
               
               
                   
                   
                   
                   
                 (4)B*- 
                 D 
               
               
                   
                   
                   
                   
                 reamp 
               
               
                 T48753 
                 14I 
                 R. leg aspirate 
                   E. coli  - heavy 
                 (1)A 
                 M 
                 
                   E. coli 
                 
                 100 
                 Jun. 13, 1997 
               
               
                   
                   
                   
                   Enterococcus  sp. - rare 
                 (2)B 
                 N 
                 
                   E. coli 
                 
                 100 
               
               
                   
                   
                   
                   
                 (3)931* 
                 N 
               
               
                 T45000 
                 16I 
                 Peritoneal fluid 
                   S. marcescens  - mod. 
                 (1)A 
                 M 
                 
                   Legionella 
                 
                 92 
                 Jun. 13, 1997 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                   S. marcescens  and 
                 98 
               
               
                   
                   
                   
                   
                   
                   
                 others 
               
               
                   
                   
                   
                   
                 (3)A 
                 N 
                 
                   Ser. marcescens 
                 
                 97 
               
               
                   
                   
                   
                   
                 (3)931-A* 
                 N 
               
               
                 T46015 
                 17I 
                 Abdominal fluid 
                   E. coli  - rare 
                 (1)A 
                 M 
                 
                   E. coli 
                 
                 100 
                 Jun. 13, 1997 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                 
                   E. coli 
                 
                 99 
               
               
                   
                   
                   
                   
                 (3)931* 
                 N 
               
               
                 W48038 
                 20I 
                 CSF 
                   S. marcescens  - rare 
                 (2)A 
                 M 
                 
                   Serratia marcescens 
                 
                 99 
                 Jun. 13, 1997 
               
               
                 X25530 
                 22I 
                 Peritoneal fluid 
                 
                   S. aureus 
                 
                 (1)A* 
                 M 
                   
                   
                 Jun. 13, 1997 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                 
                   Staph. aureus 
                 
                 100 
               
               
                   
                   
                   
                   
                   
                   
                   
                 100 
               
               
                   
                   
                   
                   
                 (3)A 
                 N 
                 
                   Staph. aureus 
                 
                 99 
               
               
                   
                   
                   
                   
                 (3)931-A* 
                 N 
               
               
                 X25803 
                 24I 
                 Ventricular CSF 
                   S. aureus  - mod. 
                 (1)A 
                 M 
                 
                   S. aureus 
                 
                 100 
                 Jun. 13, 1997 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                 
                   Staph, aureus 
                 
                 99 
               
               
                   
                   
                   
                   
                 (3)931* 
                 N 
               
               
                 F46714 
                 25I 
                 Peritoneal fluid 
                   S. marcescens  - rare 
                 (1)A 
                 M 
                 
                   Legionella 
                 
                 93 
                 Jun. 13, 1997 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                 
                   S. marcescens 
                 
                 97 
               
               
                   
                   
                   
                   
                 (2)931* 
                 N 
                 
                   Ser. marcescens 
                 
               
               
                   
                   
                   
                   
                 (3)A 
                 N 
                   
                 97 
               
               
                   
                   
                   
                   
                 (3)931-A* 
                 N 
               
               
                 W48390 
                 26I 
                 Knee fluid 
                 Grp. B  Strep.  - mod. 
                 (3)A* 
                 M 
                   
                   
                 Jun. 13, 1997 
               
               
                   
                   
                   
                   
                 (4)B 
                 N 
                 
                   Strep. 
                 
                 100 
               
               
                   
                   
                   
                   
                 (5)A* 
                 N 
               
               
                   
                   
                   
                   
                 (5)931-A* 
                 N 
               
               
                 X25714 
                 27I 
                 Jackson pratt fluid 
                   Enterobacter cloacae  - 
                 (1)A 
                 M 
                 
                   Enterobacter 
                 
                 99 
                 Jun. 13, 1997 
               
               
                   
                   
                   
                 heavy 
                   
                   
                 
                   Klebsiella 
                 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                   Enterobact.  sp.,  Kleb.   
                 98 
               
               
                   
                   
                   
                   
                   
                   
                 sp. 
               
               
                   
                   
                   
                   
                 (3)931* 
                 N 
               
               
                 H53080 
                 28I 
                 CSF 
                   S. marcescens  - light 
                 (1)A 
                 M 
                 
                   S. marcescens 
                 
                 90 
                 Jun. 13, 1997 
               
               
                   
                   
                   
                   
                 (2)B* 
                 N 
               
               
                   
                   
                   
                   
                 (3)A* 
                 N 
               
               
                   
                   
                   
                   
                 (3)931-A* 
                 N 
               
               
                 T48303 
                 29I 
                 RLQ drain 
                   Enterococcus  sp. - mod. 
                 (1)A* 
                 M 
                   
                   
                 Jun. 13, 1997 
               
               
                   
                   
                   
                 CNS - mod. 
               
               
                   
                   
                   
                 
                   Candida albicans 
                 
                 (2)B 
                 N 
                   Lactobacillus  sp., 
                 100 
               
               
                   
                   
                   
                 (fungus)- mod. 
                   
                   
                   Enterocooccus  sp. 
                 100 
               
               
                   
                   
                   
                   
                 (3)A 
                 N 
                 
                   Enterococcus 
                 
                 100 
               
               
                 M69761 
                 34I 
                 T/tube fluid 
                 
                   Enterobacter sakaqaii 
                 
                 (1)A 
                 M 
                 
                   Enterobacter sakagaii 
                 
                 99 
                 Aug. 19, 1997 
               
               
                   
                   
                   
                   Enterococcus  sp 
                   
                   
                 
                   Klebsiella 
                 
                 BF-100 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                   E. coli ,  Kleb.  sp., 
                 100 
               
               
                   
                   
                   
                   
                   
                   
                   Enterobac.  sp. 
               
               
                   
                   
                   
                   
                 (3)931 
                 N 
                 
                   Enterobacter sakagaii 
                 
                 97 
               
               
                   
                   
                   
                   
                   
                   
                   
                 97 
               
               
                 T827 
                 36I 
                 Pancreatic fluid 
                 CNS 
                 (1)A 
                 M 
                 
                   Streptococcus 
                 
                 89 
                 Aug. 19, 1997 
               
               
                   
                   
                   
                 
                   Strep. viridans 
                 
                   
                   
                 
                   viridans 
                 
               
               
                   
                   
                   
                   
                 (2)B* 
                 N 
               
               
                   
                   
                   
                   
                 (3)B* 
                 N 
               
               
                   
                   
                   
                   
                 (4)A 
                 N 
                 
                   Strep. viridans 
                 
                 88 
               
               
                 W9648 
                 39I 
                 CSF 
                 MRSA - heavy 
                 (1)A 
                 M 
                 
                   Staphylococcus 
                 
                 100 
                 Sep. 9, 1997 
               
               
                   
                   
                   
                   
                 (3)B 
                 N 
                 
                   Legionella 
                 
                 92 
               
               
                 X42186 
                 41I 
                 T-tube 
                 
                   Candida albicans 
                 
                 (1)A 
                 M 
                 
                   Staphylococcus 
                 
                 99 
                 Sep. 9, 1997 
               
               
                   
                   
                   
                 (fungus)- heavy 
                 (2)B* 
                 N 
               
               
                   
                   
                   
                 CNS Meth. resistant - 
                 (2)931* 
                 N 
               
               
                   
                   
                   
                 heavy 
               
               
                   
                   
                   
                   Eikenalla carrodens  - mod. 
                 (3)B 
                 N 
                 
                   Staph 
                 
                 100 
               
               
                   
                   
                   
                 
                   Candida tropicalis 
                 
               
               
                   
                   
                   
                 (fungus)- heavy 
               
               
                 T9271 
                 50I 
                 CSF 
                   Staph. aureus  - light 
                 (1)A 
                 M 
                 
                   Staph. aureus 
                 
                 100 
                 Sep. 9, 1997 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                 
                   Staph. aureus 
                 
                 100 
               
               
                   
                   
                   
                   
                 (2)931* 
                 N 
               
               
                 F12076 
                 54I 
                 Bile 
                   Enterobacter cloacae  - 
                 (1)A 
                 M 
                 
                   Klebsiella oxytoca 
                 
                 100 
                 Sep. 30, 1997 
               
               
                   
                   
                   
                 heavy 
                   
                   
                 
                   Enterobacter cloacae 
                 
                 100 
               
               
                   
                   
                   
                   Enterococcus  sp. - light 
                   
                   
                   
                 100 
               
               
                   
                   
                   
                   Klebsiella oxytoca  - light 
                   
                   
                   
                 100 
               
               
                   
                   
                   
                 
                   Candida albicans 
                 
                 (2)B 
                 N 
                 
                   Kleb. oxytoca 
                 
                 100 
               
               
                   
                   
                   
                 (fungus)- light 
               
               
                 X46327 
                 55I 
                 Bile 
                   Klebsiella oxytoca  - heavy 
                 (1)A 
                 M 
                 
                   Klebsiella oxytoca 
                 
                 100 
                 Sep. 30, 1997 
               
               
                   
                   
                   
                   E. coli  - heavy 
               
               
                   
                   
                   
                   Enterococcus  sp - heavy 
                 (2)B 
                 N 
                 
                   Kleb. oxytoca 
                 
                 99 
               
               
                   
                   
                   
                   Strep. viridans  - heavy 
                   
                   
                   Enterobacteria  sp. 
                 99 
               
               
                 H33952 
                 58I 
                 Aqueous humor 
                   Strep. pneumo.  - heavy 
                 (1)A* 
                 M 
                   
                   
                 Oct. 20, 1997 
               
               
                   
                   
                 (eye) 
                   
                 (2)B 
                 N 
                 
                   Strep. pneumoniae 
                 
                 100 
               
               
                   
                   
                   
                   
                 (2)931* 
                 N 
               
               
                   
                   
                   
                   
                 (3)A 
                 D 
                 
                   Strep. pneumoniae 
                 
                 95 
               
               
                 M26174 
                 60I 
                 Left pleural fluid 
                   Enterococcus  sp. - rare 
                 (2)A 
                 M 
                 
                   Enterococcus 
                 
                 100 
                 Nov. 18, 1997 
               
               
                   
                   
                   
                   
                 (3)B 
                 N 
                 
                   Enterococcus 
                 
                 100 
               
               
                 M26178 
                 61I 
                 Right pleural fluid 
                   Enterococcus  sp. - rare 
                 (2)A 
                 M 
                 
                   Enterococcus 
                 
                 100 
                 Nov. 18, 1997 
               
               
                   
                   
                   
                   
                 (3)B 
                 N 
                 
                   Enterococcus 
                 
                 100 
               
               
                 X52908 
                 64I 
                 Abscess fluid 
                   Enterobacter aerogenes  - 
                 (1)A 
                 M 
                 
                   Enterobacter 
                 
                 100 
                 Nov. 18, 1997 
               
               
                   
                   
                   
                 heavy 
                   
                   
                 
                   aerogenes 
                 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                 
                   Enterobacter 
                 
                 98 
               
               
                   
                   
                   
                   
                   
                   
                 
                   aerogenes 
                 
               
               
                 H34581 
                 66I 
                 Pelvic abscess 
                   Peptostrep  sp. - mod. 
                 (2)A 
                 M 
                 
                   Peptostreptococcus 
                 
                 96 
                 Nov. 18, 1997 
               
               
                   
                   
                   
                   Bacteriodes caccae  - mod. 
                 (3)B 
                 N 
                   Strep.  sp. 
                 100 
               
               
                 H36540 
                 67I 
                 Liver fluid 
                 
                   Bacteriodes coccae 
                 
                 (1)A 
                 M 
                 
                   B. fragilis 
                 
                 93 
                 Nov. 18, 1997 
               
               
                   
                   
                   
                 
                   Bacteriodes fragelis 
                 
               
               
                   
                   
                   
                 
                   Prop. granulosum 
                 
                 (2)B 
                 N 
                   Lactobacillus  (several) 
                 100 
               
               
                 F26285 
                 68I 
                 Fluid 
                 
                   Bacteriodes coccae 
                 
                 (1)A 
                 M 
                 
                   Bacteriodes 
                 
                 98 
                 Nov. 18, 1997 
               
               
                   
                   
                   
                 
                   Bacteriodes 
                 
                 (2)B 
                 N 
                 
                   Bacteriodes 
                 
                 99 
               
               
                   
                   
                   
                 
                   thetarotaomcron 
                 
               
               
                   
                   
                   
                 
                   Bacteriodes melanogencus 
                 
               
               
                   
                   
                   
                 
                   Bacteriodes 
                 
               
               
                   
                   
                   
                 
                   loeschiu/dentiediu 
                 
               
               
                 H41847 
                 70I 
                 Thoracentesis 
                 
                   Strep. bovis 
                 
                 (1)A 
                 M 
                 
                   Streptococcus bovis 
                 
                 97 
                 Nov. 18, 1997 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                 
                   Strep. bovis 
                 
                 100 
               
               
                 T35608 
                 72I 
                 Pleural fluid 
                 
                   Ps. aeruginosa 
                 
                 (2)A 
                 M 
                 
                   Pseudomonas 
                 
                 98 
                 Nov. 18, 1997 
               
               
                   
                   
                   
                   Enterococcus  sp. 
                   
                   
                 
                   aeruginosa 
                 
               
               
                   
                   
                   
                 
                   Candida parapsilosis 
                 
                 (3)B 
                 N 
                 
                   Ps. aeruginosa 
                 
                 98 
               
               
                   
                   
                   
                 (fungus) 
               
               
                 S67044 
                 74I 
                 CSF 
                 
                   Acinetobacter 
                 
                 (1)A 
                 M 
                 
                   Acinetobacter 
                 
                 99 
                 Nov. 18, 1997 
               
               
                   
                   
                   
                 
                   calcoacetieus 
                 
                   
                   
                 
                   calcoacetieus 
                 
                 100 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                 
                   Acinetobacter 
                 
                 99 
               
               
                   
                   
                   
                   
                   
                   
                 
                   calcoacetieus 
                 
               
               
                 F32952 
                 76I 
                 Fluid from heel 
                 
                   Ser. marcescens 
                 
                 (1)A 
                 M 
                 
                   Serratia marcescens 
                 
                 100 
                 Dec. 16, 1997 
               
               
                   
                   
                   
                 
                   Enterococcus 
                 
                 (3)B 
                 N 
                 
                   Ser. marcescens 
                 
                 97 
               
               
                 M38413 
                 77I 
                 Abscess - kidney 
                 
                   E. coli 
                 
                 (2)A 
                 M 
                 
                   E. coli 
                 
                 100 
                 Dec. 16, 1997 
               
               
                   
                   
                   
                   
                   
                   
                   
                 100 
               
               
                   
                   
                   
                   
                 (3)B 
                 N 
                 
                   E. coli 
                 
                 97 
               
               
                 T38404 
                 78I 
                 Nephrostomy fluid 
                 
                   Ser. marcescens 
                 
                 (2)A 
                 M 
                 
                   S. marcescens 
                 
                 98 
                 Dec. 16, 1997 
               
               
                   
                   
                   
                   
                 (3)B 
                 N 
                 
                   Ser. marcescens 
                 
                 97 
               
               
                 T43701 
                 86I 
                 Bile 
                 
                   Serratia liquifaciens 
                 
                 (1)A* 
                 M 
                   
                   
                 Dec. 16, 1997 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                 
                   Serratia liguifaciens 
                 
                 98 
               
               
                   
                   
                   
                   
                 (2)931* 
                 N 
               
               
                   
                   
                   
                   
                 (3)A 
                 N 
                 
                   Ser. liguifaciens 
                 
                 99 
               
               
                   
                   
                   
                   
                 (3)931-A 
                 N 
                 
                   Ser. liguifaciens 
                 
                 92 
               
               
                 S919 
                 87I 
                 Peritoneal fluid 
                 Coag. neg.  staph   
                 (1)A 
                 M 
                 
                   Staphylococcus 
                 
                 97 
                 Dec. 16, 1997 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                   Staph.  ( 
                 100 
               
               
                 X62355 
                 88I 
                 Elbow fluid 
                 B Group A  strep   
                 (1)A 
                 M 
                 
                   Streptococcus 
                 
                 100 
                 Dec. 16, 1997 
               
               
                   
                   
                   
                   
                 2(B) 
                 N 
                 
                   Strep. 
                 
                 100 
               
               
                 M46066 
                 89I 
                 Asperata 
                   Entero  sp. 
                 (1)A* 
                 M 
                   
                   
                 Dec. 16, 1997 
               
               
                   
                   
                   
                   Coryne  sp. 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                   Enterococcus  sp. 
                 98 
               
               
                   
                   
                   
                   
                 (2)931* 
                 N 
               
               
                   
                   
                   
                   
                 (3)A* 
                 N 
               
               
                   
                   
                   
                   
                 (3)931-A* 
                 N 
               
               
                 M46395 
                 90I 
                 Pleural fluid 
                 
                   Kleb. pneumonae 
                 
                 (1)A 
                 M 
                 
                   K. pneumoniae 
                 
                 96 
                 Dec. 16, 1997 
               
               
                   
                   
                   
                   Coryne  sp. 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                 
                   Kleb. pneumoniae 
                 
                 98 
               
               
                 M47004 
                 91I 
                 Synovial fluid 
                 Beta  strep  A 
                 (2)A 
                 M 
                 
                   Streptococcus 
                 
                 100 
                 Dec. 16, 1997 
               
               
                   
                   
                   
                   
                 (3)B 
                 N 
                 
                   Strep. 
                 
                 93 
               
               
                 M47005 
                 92I 
                 Elbow fluid 
                 Beta  strep  A 
                 (1)A* 
                 M 
                   
                   
                 Dec. 16, 1997 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                 
                   Strep. 
                 
                 100 
               
               
                   
                   
                   
                   
                 (2)931* 
                 N 
               
               
                   
                   
                   
                   
                 (3)A 
                 N 
                 
                   Strep. 
                 
                 98 
               
               
                   
                   
                   
                   
                 (3)931-A* 
                 N 
               
               
                 F42928 
                 94I 
                 Abdominal fluid 
                 
                   S. aureus 
                 
                 (2)A 
                 M 
                 
                   S. aureus 
                 
                 100 
                 Dec. 16, 1997 
               
               
                   
                   
                   
                   
                 (3)B 
                 N 
                 
                   Staph. aureus 
                 
                 100 
               
               
                 F43164 
                 95I 
                 Bile 
                 
                   Ps. aeruginosa 
                 
                 (1)A* 
                 M 
                   
                   
                 Dec. 16, 1997 
               
               
                   
                   
                   
                   Enterococcus  sp. 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                 
                   Pseudomonas 
                 
                 96 
               
               
                   
                   
                   
                   
                   
                   
                 
                   aeruginosa 
                 
               
               
                   
                   
                   
                   
                 (3)931 
                 N 
                 
                   Pseudomonas 
                 
                 97 
               
               
                   
                   
                   
                   
                 (4)A 
                 N 
                 
                   aeruginosa 
                 
                 98 
               
               
                   
                   
                   
                   
                 (4)931-A* 
                 N 
                 
                   Pseudomonas. 
                 
               
               
                   
                   
                   
                   
                   
                   
                 
                   aeruginosa 
                 
               
               
                 F45280 
                 96I 
                 JP drainage 
                 
                   Strep ocudans 
                 
                 (2)A 
                 M 
                 
                   Streptococcus 
                 
                 98 
                 Jan. 6, 1998 
               
               
                   
                   
                   
                   Coryne  sp. 
                   
                   
                 
                   ocudans 
                 
               
               
                   
                   
                   
                 Coag. Neg.  Staph.   
                 (3)B* 
                 N 
               
               
                   
                   
                   
                   
                 (4)B 
                 N 
                 
                   Strep. ocudans 
                 
                 100 
               
               
                 T50295 
                 100I  
                 CSF 
                 Coag. Heg.  Staph.   
                 (1)A 
                 M 
                 
                   Staphylococcus 
                 
                 100 
                 Jan. 6, 1998 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                 
                   Staph. 
                 
                 100 
               
               
                 W60881 
                 107I  
                 Bile 
                 
                   K. pneumo 
                 
                 (1)A 
                 M 
                 
                   Lactobacillus 
                 
                 98 
                 Jan. 15, 1998 
               
               
                   
                   
                   
                 
                   Enterococcus 
                 
               
               
                   
                   
                   
                 
                   Lactobacillus 
                 
                 (2)B 
                 N 
                   Lactobacillus  sp. 
                 100 
               
               
                   
                   
                   
                 Yeast 
               
               
                   
                   
                   
                   
                 (3)931 
                 N 
                 
                   Lactobacillus 
                 
                 97 
               
               
                 T55158 
                 109I  
                 Chest drainage 
                 
                   Ent. faecium 
                 
                 (1)A* 
                 M 
                   
                   
                 Jan. 15, 1998 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                 
                   Ent. faecium 
                 
                 100 
               
               
                   
                   
                   
                   
                   
                   
                   
                 100 
               
               
                   
                   
                   
                   
                 (3)A* 
                 N 
               
               
                   
                   
                   
                   
                 (3)931-A* 
                 N 
               
               
                   
                   
                   
                   
                 (4)A* 
                 N 
               
               
                 X68623 
                 112I  
                 ICP fluid 
                 Coag. Neg.  Staph.   
                 (1)A 
                 M 
                 
                   Legionella 
                 
                 90 
                 Feb. 19, 1998 
               
               
                   
                   
                   
                   
                 (4)A 
                 D 
                 
                   Staph 
                 
                 98 
               
               
                   
                   
                   
                   
                 (4)B* 
                 D 
               
               
                 S12277 
                 113I  
                 Pelvic fluid 
                 
                   E. coli 
                 
                 (1)A 
                 M 
                 
                   E. coli 
                 
                 100 
                 Feb. 19, 1998 
               
               
                   
                   
                   
                   Enterococcus  sp. 
               
               
                   
                   
                   
                   C. albicans  (fungus) 
                 (2)B 
                 N 
                 
                   E. coli 
                 
                 100 
               
               
                   
                   
                   
                 Coag. Neg.  Staph.   
               
               
                 S12826 
                 114I  
                 Elbow fluid 
                 
                   S. aureus 
                 
                 (2)A 
                 M 
                 
                   Staph. aureus 
                 
                 100 
                 Feb. 19, 1998 
               
               
                   
                   
                   
                   
                 (3)B 
                 N 
                 
                   Staph. aureus 
                 
                 95 
               
               
                 X529 
                 115I  
                 CSF 
                 Coag. Neg.  Staph.   
                 (1)A 
                 M 
                 
                   Streptococcus xylosus 
                 
                 95 
                 Feb. 19, 1998 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                 
                   Staph. 
                 
                 100 
               
               
                 X530 
                 116I  
                 CSF 
                 Coag. Neg.  Staph.   
                 (1)A 
                 M 
                 
                   Staph. 
                 
                 100 
                 Feb. 19, 1998 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                 
                   Staph. 
                 
                 100 
               
               
                 F1545 
                 117I  
                 Joint (bursa) fluid 
                 
                   S. aureus 
                 
                 (1)A 
                 M 
                 
                   Staph. aureus 
                 
                 100 
                 Mar. 4, 1998 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                 
                   Staph. aureus 
                 
                 100 
               
               
                 M7133 
                 122I  
                 Bile 
                   C. albicans  (fungus) 
                 (1)A 
                 M 
                 
                   Streptococcus 
                 
                 96 
                 Mar. 4, 1998 
               
               
                   
                   
                   
                 
                   Strep. viridans 
                 
                   
                   
                 
                   viridans 
                 
               
               
                   
                   
                   
                   
                   
                   
                 
                   Streptococcus 
                 
               
               
                   
                   
                   
                   
                   
                   
                 
                   viridans 
                 
               
               
                 M26418 
                 126I  
                 Abdominal fluid 
                 
                   Ps aeruginosa 
                 
                 (3)A 
                 M 
                 
                   Ps. aeruginosa 
                 
                 100 
                 May 7, 1998 
               
               
                   
                   
                   
                   
                   
                   
                 
                   Ps. aeruginosa 
                 
               
               
                   
                   
                   
                   
                 (4)B 
                 N 
                 
                   Ps. aerug. 
                 
                 98 
               
               
                 F26979 
                 127I  
                 Bile 
                 
                   Ps aeruginosa 
                 
                 (1)A* 
                 M 
                   
                   
                 May 7, 1998 
               
               
                   
                   
                   
                   C. albicans  (fungus) 
                 (2)A* 
                 M 
               
               
                   
                   
                   
                   Enterococcus  sp 
                 (3)A 
                 M 
                 
                   Ps. aeruginosa 
                 
                 100 
               
               
                   
                   
                   
                   
                 (4)B 
                 N 
                 
                   Ps. aeruginosa 
                 
                 96 
               
               
                   
                   
                   
                   
                 (5)931 
                 M 
                 
                   Ps. aeruginosa 
                 
                 99 
               
               
                 F26350 
                 128I  
                 Pelvic abscess 
                   C. albicans  (fungus) 
                 (3)A* 
                 M 
                   
                   
                 May 7, 1998 
               
               
                   
                   
                   
                 CNS 
               
               
                   
                   
                   
                 
                   E. coli 
                 
               
               
                   
                   
                   
                 
                   B. vulgalis 
                 
                 (4)B 
                 N 
                 
                   Bacteriodes 
                 
                 97 
               
               
                   
                   
                   
                 
                   B. thetaiotaomicron 
                 
                   
                   
                 
                   thetaiotaomicron 
                 
               
               
                 F28102 
                 131I  
                 CSF 
                 
                   Ent. cloacae 
                 
                 (1)A 
                 M 
                 
                   Enterobacter cloacae 
                 
                 99 
                 May 7, 1998 
               
               
                   
                   
                   
                   
                 (3)B 
                 N 
                 
                   Ent. cloacae 
                 
                 98 
               
               
                 S18864 
                 132I  
                 CSF 
                 
                   Ent. cloacae 
                 
                 (1)A 
                 M 
                 
                   Enterobacter cloacae 
                 
                 99 
                 May 7, 1998 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                 
                   Ent. cloacae 
                 
                 97 
               
               
                   
                   
                   
                   
                 (3)931 
                 N 
                 
                   Ent. cloacae 
                 
                 99 
               
               
                   
                   
                   
                   
                   
                   
                   
                 99 
               
               
                 X16529 
                 137I  
                 CSF 
                 
                   Ent. cloacae 
                 
                 (1)A 
                 M 
                 
                   Enterobacter cloacae 
                 
                 100 
                 Jun. 10, 1998 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                 
                   Enterobac. cloacae 
                 
                 100 
               
               
                   
                   
                   
                   
                 (3)931 
                 N 
                 
                   Enterobacter cloacae 
                 
                 99 
               
               
                 F32412 
                 139I  
                 CSF 
                 
                   Ent. cloacae 
                 
                 (1)A 
                 M 
                 
                   Enterobacter sp. 
                 
                 100 
                 Jun. 10, 1998 
               
               
                   
                   
                   
                 
                   Ent. freundii 
                 
                   
                   
                   
                 100 
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                   Enterbac.  sp. 
                 98 
               
               
                   
                   
                   
                   
                 (2)931* 
                 N 
               
               
                 W39152 
                 147I  
                 Fluid around liver 
                 
                   Ps. aeruginosa 
                 
                 (1)A 
                 M 
                 
                   Ps. aeruginosa 
                 
                 99 
                 Jun. 10, 1998 
               
               
                   
                   
                   
                 Coag. Heg.  Staph.   
               
               
                   
                   
                   
                   
                 (2)B 
                 N 
                 
                   Ps. aeruginosa 
                 
                 100 
               
               
                   
                   
                   
                   
                 (3)931* 
                 N 
               
               
                 M38970 
                 148I  
                 Abdominal fluid 
                 
                   K. pneumo 
                 
                 A 
                 N 
                 
                   Prevotella bivia 
                 
                 98 
                 Jun. 10, 1998 
               
               
                   
                   
                   
                 
                   Prevotella bivia 
                 
               
               
                   
                   
                   
                   
                 B 
                 N 
                 
                   Prevotella bivia 
                 
                 94 
               
               
                   
                   
                   
                   
                 931 
                 N 
                 
                   Prevotella bivia 
                 
                 97 
               
               
                   
                   
                   
                   
                 1462* 
                 N 
               
               
                 M55048 
                 149I  
                 ICP fluid 
                 Coag. Neg.  Staph   
                 A 
                 N 
                 
                   Staph. 
                 
                 100 
                 Jul. 23, 1998 
               
               
                   
                   
                   
                   
                   
                   
                   
                 100 
               
               
                   
                   
                   
                   
                 B 
                 N 
                 
                   Staph. 
                 
                 95 
               
               
                   
                   
                   
                   
                 931* 
                 N 
               
               
                   
                   
                   
                   
                 1462* 
                 N 
               
               
                 F29060 
                 152I  
                 Bile 
                 
                   Ent. freundii 
                 
                 (1)A 
                 N 
                 
                   Staph 
                 
                 100 
                 Jul. 23, 1998 
               
               
                   
                   
                   
                   Enterococcus  sp. 
               
               
                   
                   
                   
                 
                   Strep. viridans 
                 
                 (1)B* 
                 N 
               
               
                   
                   
                   
                   C. albicans  (fungus) 
                 (1)931* 
                 N 
               
               
                   
                   
                   
                   C. glabrata  (fungus) 
                 (2)B 
                 N 
                   Ent.  sp. 
                 98 
               
               
                 T43605 
                 169I  
                 Aspirate 
                 
                   Strep. viridans 
                 
                 (2)A* 
                 N 
                   
                   
                 Jan. 17, 1998 
               
               
                   
                   
                   
                   
                 (4)A 
                 N 
                 
                   Strep. viridans 
                 
                 99 
               
               
                   
                   
                   
                   
                 (5)B* 
                 N 
               
               
                   
                   
                   
                   
                 (6)B* 
                 D 
               
               
                 F54210 
                 173I  
                 Chest tube drainage 
                   Enterococcus  sp. - light 
                 (4)B* 
                 N 
                   Enterococcus  sp 
                 94 
                 Mar. 15, 1999 
               
               
                 F53870 
                 174I  
                 Pleural fluid 
                   Ent. aerogenes  - mod. 
                 (4)B 
                 N 
                 
                   Ent. aerogenes 
                 
                   
                 Mar. 15, 1999 
               
               
                 W14514 
                 183I  
                 pleural fluid 
                   Strep. pneumoniae - mod 
                 (3)A 
                 D 
                 
                   Strep. pneumoniae 
                 
                 99 
                 Apr. 19, 1999 
               
               
                   
                   
                   
                   
                 (3)B 
                 D 
                 
                   Strep. pneumoniae 
                 
                   94 ## 
               
               
                   
               
            
           
         
       
     
     The results in Table 5 show that in vast majority of the cases, identification using the methods and the primer sets disclosed here produce the same results as those identified using conventional culturing methods. Of the 299 total clinical samples tested, 195 samples produced either positive or negative amplification results that are in accord with the results obtained by culturing method. Of the 145 positive amplification products sequenced, 131 produced acceptable sequence results. 114 of the 131 sequence results identified the same organism(s) as the culturing method, with one result generating more specific identification of the organism than the traditional culturing method. 4 out of 131 produced identification results that are in discordance with the results produced by culturing. An additional 12 sequencing results appeared to contain multiple sequences likely as a result of multiple organisms in the clinical sample.