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Background Within the current worldwide epidemic of community-acquired Staphylococcus aureus infections, attention has focused on the role of methicillin-resistant strains. We characterized methicillin-susceptible strains that also contribute. Methods We tracked cultures from abscesses submitted to the microbiology laboratory at St. Louis Children’s Hospital. We also sought Panton-Valentine leukocidin (PVL) genes in methicillin-susceptible Staphylococcus aureus (MSSA) isolates, and we further characterized some isolates by multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE), antibiotic susceptibility, accessory gene regulator (agr) allele, and presence of the arcA gene of the arginine catabolic mobile element (ACME). Results From 1999 to 2007, we detected a 250-fold increase in cultures of abscesses yielding methicillin-resistant Staphylococcus aureus (MRSA) and a 5-fold increase in abscess cultures yielding MSSA. MSSA isolates from abscesses and wounds were more likely to encode PVL than isolates from other sources. In contrast to PVL-negative isolates of MSSA which were genetically diverse, PVL-positive isolates were predominantly MLST 8, Agr type 1. More than half of PVL-positive MSSA isolates were resistant to erythromycin and susceptible to clindamycin with absence of inducible resistance, a pattern uncommon in PVL-negative MSSA but frequent in the USA300 clone of MRSA. In addition, PFGE of PVL-positive MSSA strains revealed the USA300 pattern. Conclusions In addition to methicillin-resistant strains, the current epidemic of Staphylococcus aureus infections includes infections caused by methicillin-susceptible strains that are closely related genetically and share phenotypic characteristics other than susceptibility to methicillin. These findings suggest that factors other than methicillin resistance are driving the epidemic.

Physical therapy is a necessary component of the rehabilitation process. Although physical therapy often succeeds in restoration of the activities of daily life, patients are often unequipped to resume their pretrauma level of activity or functional capacity, including return to work or school. We opine that a vigorous program of physical training implemented soon after discharge from physical therapy is a logical and cost-effective extension of the continuum of rehabilitation after critical illness. Such extension, supervised by an advanced exercise specialist, addresses many physical limitations that persist after critical illness and limit functional recovery.

Background: ABO-incompatible red blood cell (RBC) transfusions and acute hemolytic reactions occur infrequently, yet resultant fatalities are reported to the US Food and Drug Administration (FDA) every year. We describe a 20-year retrospective study of reported mistransfusion cases to identify temporal trends, common causes, and corrective actions taken to prevent recurrence. Study Design and Methods: ABO-incompatible RBC transfusion-related fatalities reported to the FDA in 2000-2019 were reviewed for patient demographics, primary attributed cause, contributing factors, and corrective actions. Results: Eighty reported deaths after ABO-incompatible RBC transfusion occurred in the 20-year period. A decrease in the number of cases after 2008 was sustained through 2019 (mean 6 cases/y, 2000-2009 vs 2 cases/y, 2010-2019). The estimated rate of reported mistransfusion fatalities was 1 per 2 million RBC units transfused in 2000-2009 and 1 per 7.14 million RBC units in 2010-2019 (P < .0001). Administration errors (wrong patient or wrong unit transfused) and sample collection errors (wrong blood in tube [WBIT]) significantly decreased over time but remained the most common causes. In all WBIT cases, verification of patients' ABO type with a second sample or historical type was not performed before transfusion; 16 of 19 (84%) institutions that reported corrective actions subsequently instituted this requirement. In the other categories, 22 of 58 (38%) facilities reported plans for technological process improvements, such as electronic patient identification. Conclusions: The rate of reported fatalities from ABO-incompatible RBC transfusion has significantly decreased in the past decade. Still, about two cases are reported each year, highlighting gaps in best practices and areas for improvement. K E Y W O R D S RBC transfusion, transfusion complications-noninfectious, transfusion practices (adult) 1 | INTRODUCTION Transfusions of ABO-incompatible red blood cells (RBCs) have long been considered preventable errors that should never occur, yet resultant acute hemolytic transfusion