Vancomycin Monotherapy May Be Insufficient to Treat Methicillin-resistant Staphylococcus aureus Coinfection in Children With Influenza-related Critical Illness.

Background: Coinfection with influenza virus and methicillin-resistant Staphylococcus aureus (MRSA) causes life-threatening necrotizing pneumonia in children. Sporadic incidence precludes evaluation of antimicrobial efficacy. We assessed the clinical characteristics and outcomes of critically ill children with influenza-MRSA pneumonia and evaluated antibiotic use. Methods: We enrolled children (<18 years) with influenza infection and respiratory failure across 34 pediatric intensive care units 11/2008-5/2016. We compared baseline characteristics, clinical courses, and therapies in children with MRSA coinfection, non-MRSA bacterial coinfection, and no bacterial coinfection. Results: We enrolled 170 children (127 influenza A, 43 influenza B). Children with influenza-MRSA pneumonia (N = 30, 87% previously healthy) were older than those with non-MRSA (N = 61) or no (N = 79) bacterial coinfections. Influenza-MRSA was associated with increased leukopenia, acute lung injury, vasopressor use, extracorporeal life support, and mortality than either group (P ≤ .0001). Influenza-related mortality was 40% with MRSA compared to 4.3% without (relative risk [RR], 9.3; 95% confidence interval [CI], 3.8-22.9). Of 29/30 children with MRSA who received vancomycin within the first 24 hours of hospitalization, mortality was 12.5% (N = 2/16) if treatment also included a second anti-MRSA antibiotic compared to 69.2% (N = 9/13) with vancomycin monotherapy (RR, 5.5; 95% CI, 1.4, 21.3; P = .003). Vancomycin dosing did not influence initial trough levels; 78% were <10 µg/mL. Conclusions: Influenza-MRSA coinfection is associated with high fatality in critically ill children. These data support early addition of a second anti-MRSA antibiotic to vancomycin in suspected severe cases.

Comparison of sand-based water filters for point-of-use arsenic removal in China.

Contamination of groundwater wells by arsenic is a major problem in China. This study compared arsenic removal efficiency of five sand-based point-of-use filters with the aim of selecting the most effective filter for use in a village in Shanxi province, where the main groundwater source had arsenic concentration >200 µg/L. A biosand filter, two arsenic biosand filters, a SONO-style filter and a version of the biosand filter with nails embedded in the sand were tested. The biosand filter with embedded nails was the most consistent and effective under the study conditions, likely due to increased contact time between water and nails and sustained corrosion. Effluent arsenic was below China's standard of 50 µg/L for more than six months after construction. The removal rate averaged 92% and was never below 86%. In comparison, arsenic removal for the nail-free biosand filter was never higher than 53% and declined with time. The arsenic biosand filter, in which nails sit in a diffuser basin above the sand, performed better but effluent arsenic almost always exceeded the standard. This highlights the positive impact on arsenic removal of embedding nails within the top layer of biosand filter sand and the promise of this low-cost filtration method for rural areas affected by arsenic contamination.