The rates of DAI in the Colombian ICUs were lower than those published in some reports from other Latin American countries and were higher than those reported in US ICUs by the NNIS. These data show the need for more-effective infection control interventions in Colombia.

Admission of patients who have do not resuscitate (DNR) status to an intensive care unit (ICU) is potentially a misallocation of limited resources to patients who may neither need nor want intensive care. Yet, patients who have DNR status are often admitted to the ICU. This is a retrospective review of patients who had a valid DNR status at the time that they were admitted to an ICU in a single hospital over an eighteen-month period. Thirty-five patients met the criteria for inclusion in the study. The primary reasons for admission to the ICU were respiratory distress (54.2%) and sepsis (45.7%). Sixteen (45.7%) of the patients died, compared to a 5.4% mortality rate for all patients admitted to our ICU during this period (p < 0.001). APACHE II score was a significant predictor of mortality (18.5 ± 1.3 alive and 23.4 ± 1.4 dead; p = 0.038). Of the 19 patients discharged alive, 9 were discharged home, 5 to hospice, and 4 to a post-acute care facility. Conclusions. Patients who have DNR status and are admitted to the ICU have a higher mortality than other ICU patients. Those who survive have a high likelihood of being discharged to hospice or a post-acute care facility. The value of intensive intervention for these patients is not supported by these results. Only a minority of patients were seen by palliative care and chaplain teams, services which the literature supports as valuable for DNR patients. Our study supports the need for less expensive and less intensive but more appropriate resources for patients and families who have chosen DNR status.

Background The coronavirus disease 2019 (COVID-19) pandemic is the largest global event in recent times, with millions of infected people and hundreds of thousands of deaths worldwide. Colombia has also been affected by the pandemic, including by the cancellation of medically necessary surgical procedures that were categorized as nonessential. The objective of this study was to show the results of the program implemented in two institutions in Bogotá, Colombia, in April 2020 to support the performance of elective essential and nonessential low- and medium-complexity orthopedic surgeries during the mitigation phase of the COVID-19 pandemic, which involved a presurgical clinical protocol without serological or molecular testing. Methods This was a multicenter, observational, retrospective, descriptive study of a cohort of patients who underwent elective orthopedic surgery at two institutions in the city of Bogota, Colombia, in April 2020. We implemented a preoperative clinical protocol that did not involve serological or molecular tests; the protocol consisted of a physical examination, a survey of symptoms and contact with confirmed or suspected cases, and presurgical isolation. We recorded the types of surgeries, the patients’ scores on the medically necessary, time-sensitive (MeNTs) scale, the presence of signs, symptoms, and mortality associated with COVID-19 developed after the operation. Results A total of 179 patients underwent orthopedic surgery. The average age was 47 years (Shapiro-Wilk, P = 0.021), and the range was between 18 and 81 years. There was a female predominance (61.5%). With regard to the types of surgeries, 86 (48%) were knee operations, 42 (23.5%) were hand surgeries, 34 (19%) were shoulder surgeries, and 17 (9.5%) were foot and ankle surgeries. The average MeNTs score was 44.6 points. During the 2 weeks after surgery, four patients were suspected of having COVID-19 because they developed at least two symptoms associated with the disease. The incidence of COVID-19 in the postoperative period was 2.3%. Two (1.1%) of these four patients visited an emergency department where RT-PCR tests were performed, and they tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). No patients died or were hospitalized for symptoms of COVID-19. Conclusion Through the implementation of a presurgical clinical protocol consisting of a physical examination; a clinical survey inquiring about signs, symptoms, and epidemiological contact with suspected or confirmed cases; and presurgical isolation but not involving the performance of molecular or serological diagnostic tests, positive results were obtained with regard to the performance of low- and medium-complexity elective orthopedic surgeries in an early stage of the COVID-19 pandemic. Level of evidence IV.

During this study period, 7,216 positive blood cultures were identified. Of these, 87 (1.2%) blood cultures from 54 patients showed S. maltophilia growth. The mean age of the patients was 53.3 ± 3.0 years. In 52 patients (96%), S. maltophilia bacteremia was hospitalacquired, in particular, in 49 patients (91%) it developed after prolonged hospitalization of >2 weeks. Forty-one patients (76%) had an indwelling central venous catheter (CVC), 50 (93%) had received antibiotic therapy, 48 (89%) had underlying malignancy, 11 (20%) had diabetes mellitus, and 11 (20%) were receiving corticosteroid therapy. In 19% of all the cases of bacteremia, polymicrobial isolates were confirmed. The overall and bacteremia-related mortality rates were 39% and 26%, respectively. The most common sources of bacteremia were CVC (33%) and pneumonia (15%); the source was unknown in 20% cases. Tests for antibiotic susceptibility revealed that the isolates were most sensitive to trimethoprimsulfamethoxazole (79%). Only 47% and 43% of the isolates were susceptible for ceftazidime and ciprofloxacin, respectively. Univariate analysis revealed that bacteremia originating from the pneumonia, patients treated with inappropriate antibiotics, and patients with a persistent indwelling CVC had a significant higher mortality rate (P < 0.0001, P < 0.0001, P = 0.0027, respectively).Conclusion: S. maltophilia is an important pathogen, particularly, in immunocompromised hosts. Isolation of this organism from a blood culture should prompt a careful review of the patient, with particular emphasis on removal of an indwelling CVC and commencement of appropriate antibiotic therapy. In this study, we noticed an increasing trend of resistance to ceftazidime, cefepime, and ciprofloxacin. Therefore, we believe that proper usage of antibiotics is important for infection control.