C. auris is an emerging and opportunistic multidrug-resistant human pathogen. It is necessary to strengthen measures to achieve an accurate and quick identification and also to avoid its dissemination. This will require improvements in health and infection control measures, as well as the promotion of antifungal stewardship in healthcare facilities.

Background Lactococcus garvieae is an unusual cause of infective endocarditis (IE). No current diagnostic and therapeutic guidelines are available to treat IE caused by these organisms. Based on a case report, we provide a review of the literature of IE caused by L. garvieae and highlight diagnostic and treatment challenges of these infections and implications for management. Case presentation A 50-year-old Asian male with mitral prosthetic valve presented to the hospital with intracranial haemorrhage, which was successfully treated. Three weeks later, he complained of generalized malaise. Further work up revealed blood cultures positive for Gram-positive cocci identified as L. garvieae by MALDI-TOF. An echocardiogram confirmed the diagnosis of IE. Susceptibility testing showed resistance only to clindamycin. Vancomycin plus gentamicin were started as empirical therapy and, subsequently, the combination of ceftriaxone plus gentamicin was used after susceptibility studies were available. After two weeks of combination therapy, ceftriaxone was continued as monotherapy for six additional weeks with good outcome. Conclusions Twenty-five cases of IE by Lactococcus garvieae have been reported in the literature. Compared to other Gram-positive cocci, L. garvieae affects more frequently patients with prosthetic valves. IE presents in a subacute manner and the case fatality rate can be as high as 16%, comparable to that of streptococcal IE (15.7%). Reliable methods for identification of L. garvieae include MALDI-TOF, 16S RNA PCR, API 32 strep kit and BD Automated Phoenix System. Recommended antimicrobials for L. garvieae IE are ampicillin, amoxicillin, ceftriaxone or vancomycin in monotherapy or in combination with gentamicin.

Background: Colombia detected its first coronavirus disease 2019 (COVID-19) case on March 2, 2020. From March 22 to April 25, it implemented a national lockdown that, apparently, allowed the country to keep a low incidence and mortality rate up to mid-May. Forced by the economic losses, the government then opened many commercial activities, which was followed by an increase in cases and deaths. This paper presents a critical analysis of the Colombian surveillance data in order to identify strengths and pitfalls of the control measures. Methods: A descriptive analysis of PCR-confirmed cases between March and July 25 was performed. Data were described according to the level of measurement. Incidence and mortality rates of COVID-19 were estimated by age, sex, and geographical area. Sampling rates for suspected cases were estimated by geographical area, and the potential for case underestimation was assessed using sampling differences. Results: By July 25, Colombia (population 50 372 424) had reported 240 745 cases and 8269 deaths (case fatality rate of 3.4%). A total of 1 370 271 samples had been analyzed (27 405 samples per million people), with a positivity rate of 17%. Sampling rates per million varied by region from 2664 to 158 681 per million, and consequently the incidence and mortality rates also varied. Due to geographical variations in surveillance capacity, Colombia may have overlooked up to 82% of the actual cases. Conclusion: Colombia has a lower case and mortality incidence compared to other South American countries. This may be an effect of the lockdown, but may also be attributed, to some extent, to geographical differences in surveillance capacity. Indigenous populations with little health infrastructure have been hit the hardest.