Staphylococcus aureus infections are an important cause of morbidity and mortality among patients in intensive care units (ICUs), particularly those with multiple comorbidities and critical conditions. Methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) strains differ in resistance, clinical behavior, and prognoses, making it important to understand their effects on clinical outcomes. Comparing clinical outcomes of MRSA and MSSA infections is important. This retrospective cohort study analyzed ICU patients with confirmed S. aureus infections at a quaternary care hospital. Demographic, clinical, and comorbidity data were collected. Poisson regression was used to analyze 7-day mortality and identify adjusted risk factors. Seven-day mortality was higher in patients with MSSA than MRSA infections, with an adjusted relative risk for MRSA of 0.380 (95% confidence interval: 0.15–0.95; p = 0.039). Independent risk factors for mortality included lack of an infectious disease consultation, vascular comorbidities, such as peripheral vascular disease and cerebrovascular events, chronic kidney disease, and inotropic support requirement. Patients with MRSA infections required significantly longer ventilatory support (mean 43.5 days vs. 13 days for MSSA; p = 0.019). Staphylococcus aureus infections in ICU patients were associated with poor outcomes, particularly in patients without infectious disease consultation and those with vascular comorbidities. Mortality differences between MRSA and MSSA highlight the importance of appropriate empiric therapy and standardized protocols incorporating infectious disease consultation to improve outcomes in critically ill patients.

Data on the optimal diagnostic management of pregnant women with suspected pulmonary embolism are limited. Despite a lack of compelling evidence in some practices, clinical practice guidelines focus on the management of these patients. We present the case of a 24-year-old patient at 36 weeks of pregnancy in whom pulmonary thromboembolism (PTE) was diagnosed in a timely manner also with hemodynamic instability and echocardiographic images with clear involvement of the right cavities. She received thrombolytic therapy with alteplase 100 mg intravenously over 2 hours, which resulted in excellent outcomes for both the pregnant woman and fetus. Understanding the acute approach and management of these patients will improve our clinical practice; therefore, we reviewed a case report of a pregnant patient with high-risk PTE and compared it with current evidence. In conclusion, PE is a common disease with a high mortality rate during pregnancy. Therefore, having made a timely diagnosis using the relevant diagnostic aids and performing thrombolysis with rtPA increase the probability of survival in our patient, leading to successful results for both her and the fetus.

Background/Objectives: Leclercia adecarboxylata (L. adecarboxylata) is a rare opportunistic pathogen that can cause severe infections like empyema, particularly in immunocompromised individuals. We aim to highlight the importance of the early detection and personalized treatment of L. adecarboxylata infections in patients with comorbidities such as malignant mesothelioma. Methods: We present the case of a 57-year-old man with type 2 diabetes mellitus, hypertension, and malignant mesothelioma who developed a parapneumonic effusion that progressed to empyema. After undergoing pleurectomy and pleurodesis, intraoperative cultures identified L. adecarboxylata. Targeted antibiotic therapy was initiated based on the culture results, and the patient’s response was closely monitored. Results: The patient responded well to targeted antibiotic therapy with ampicillin/sulbactam following the initial empirical treatment with piperacillin/tazobactam. The identification of L. adecarboxylata—a rare finding in empyema cases—was crucial for effective management. The patient recovered fully without complications, highlighting the importance of the early identification and individualized treatment of infections caused by rare pathogens. Conclusions: This case underscores the need to consider L. adecarboxylata in immunocompromised patients presenting with unusual infections. Early detection through advanced diagnostic techniques and personalized antibiotic therapy can improve clinical outcomes and help prevent antimicrobial resistance. Increased clinical awareness and further research into the resistance patterns and treatment approaches for L. adecarboxylata are essential to enhance patient care.

Context and Objective: Post-Transcatheter Aortic Valve Replacement (TAVR) mortality exhibits extreme heterogeneity that conventional meta-analyses fail to explain, limiting the clinical utility of evidence synthesis and hindering accurate prognostic assessment. This study evaluated whether meta-learning, using aggregate data from the literature, can predict cohort-level mortality and identify its determinants, overcoming the limitations of traditional methods to provide a clearer understanding of the factors driving TAVR outcomes. Methods: A systematic review following PRISMA guidelines was conducted across five databases. Methodological quality was assessed with standardized tools (Risk of Bias 2, Newcastle-Ottawa Scale, Risk of Bias in Non-randomized Studies of Exposure). After performing conventional meta-analyses and meta-regressions, multiple machine learning models were trained using study-level characteristics as predictors. Advanced optimization with regularization and ensemble techniques was applied to develop a final, optimized model. Results: Fifty-eight studies, encompassing over 533,000 patients, were included. Traditional meta-analysis confirmed extreme heterogeneity (I² = 76.7% in Random Clinical Trials, 96.8% in observational studies), with no explanatory power via meta-regression. The initial AdaBoost model achieved R² = 0.191, outperforming 17 alternative algorithms. Advanced optimization developed a Blend_Optimized model that explained 65.3% of the variability (R² = 0.653), marking a substantial 46 percentage-point increase. Interpretability analysis identified four dominant predictors: Society of Thoracic Surgeons Predicted Risk of Operative Mortality (R² = 0.300), Recruitment Year (R² = 0.212), % Transfemoral (R² = 0.201), and % Diabetes (R² = 0.175), revealing a potent temporal gradient reflecting the evolution of medical practice. Conclusions: Meta-learning significantly surpasses traditional methods in extracting systematic signals from heterogeneous evidence. This study demonstrates that, in addition to patient risk factors, a significant temporal gradient models technological evolution and learning curves. The methodology transforms seemingly unexplained heterogeneity into clinically interpretable patterns, demonstrating the potential of meta-learning as a complementary tool for evidence synthesis in interventional cardiology and opening avenues for applications in other complex cardiovascular fields. Important Limitation: This model predicts cohort-level outcomes and should not be used for individual risk assessment.

La coinfección por SARS-CoV-2 e Influenza (conocida como Flurona) representa un reto diagnóstico y terapéutico relevante en el contexto pandémico y pospandémico, dada la similitud clínica y mecanismo de transmisión entre ambos virus, pero con diferencias importantes en su tratamiento. La sospecha oportuna de coinfección viral es clave, especialmente en pacientes con comorbilidades o evolución clínica atípica. Se realizó una revisión de literatura en PubMed, Scopus y Google Académico (español e inglés), identificando escasos reportes clínicos documentados en Colombia. Descripción del caso: Paciente masculino de 83 años, con antecedentes cardiovasculares significativos, hospitalizado en unidad de cuidado intensivo por insuficiencia cardíaca congestiva y valvulopatía aórtica severa. Durante la hospitalización desarrolló insuficiencia respiratoria, confirmándose coinfección por Influenza y SARS-CoV-2. Recibió tratamiento con Oseltamivir, oxigenoterapia y toracocentesis terapéutica. Se indicó implantación valvular aórtica transcatéter (TAVI), pero el paciente falleció durante el procedimiento. Conclusión:La coinfección por SARS-CoV-2 e Influenza debe ser considerada en el diagnóstico diferencial de pacientes con compromiso respiratorio agudo, particularmente en contextos de circulación viral simultánea. El reconocimiento oportuno permite una intervención terapéutica dirigida. El abordaje multidisciplinario es fundamental para optimizar el pronóstico en pacientes con comorbilidades complejas.