Introducción: El uso inapropiado de antibióticos en unidades de cuidados intensivos conlleva riesgos como el aumento de infecciones causadas por bacterias multiresistentes y reacciones adversas. La estrategia de la Organización Mundial de la Salud, denominada Acceso, Vigilancia y Reserva, tiene como objetivo mitigar estos riesgos al clasificar los antibióticos en estas categorías. Objetivo: Caracterizar el consumo de antibióticos en la población adulta de las unidades de cuidados intensivos durante el primer trimestre de 2023. Materiales y Métodos: Se realizó un estudio transversal de pacientes en unidades de cuidados intensivos. Se llevó a cabo un análisis bivariado y multivariado con regresión logística. Resultados: Se estudiaron 807 pacientes en unidades de cuidados intensivos, con una edad media de 60 años. El antibiótico más prescrito fue Piperacilina/Tazobactam. En la clasificación de Acceso, Vigilancia y Reserva, el 77.96% de las prescripciones fueron Vigilancia, el 11.29% Reserva y el 10.75% Acceso. Discusión: El uso de antibióticos en las unidades de cuidados intensivos es crucial para el manejo de pacientes críticamente enfermos. Nuestro estudio se centra en los desafíos de la selección de antibióticos, el manejo de complicaciones y enfatiza la administración para una terapia óptima y una reducción de la resistencia. Conclusión: Es crucial realizar un estudio de intervención que demuestre cómo aumentar la interacción entre el equipo de administración de antimicrobianos durante la prescripción puede mejorar su uso, reducir los efectos secundarios y disminuir los costos innecesarios.

Introduction: Understanding the impact of value-based healthcare and various healthcare payment models on the health outcomes of patients with acute myocardial infarction (AMI) is pivotal for guiding clinical strategies and decisions. Objective: To compare health outcomes and costs associated with healthcare for AMI patients under insurance prospective global payment (PGP) and fee-for-service models. Materials and Methods: A retrospective cohort study encompassing AMI patients was conducted from 2021-2023. Convenience sampling of participants over 18 years of age diagnosed with type 2 myocardial infarction was conducted. Analysis was based on Colombian healthcare system payment models: PGP and fee-for-service. Results: The study involved 2134 patients, 657 (31%) under PGP and 1477 (69%) under fee-for-service. Length of hospital stay was associated with the payment model (coefficient -0.68, CI 95%: 0.40 to 0.98, p=0.037). Payment models also correlated with costs (845 USD, CI 95%: 87.92 to 1601; p=0.02 ). In-hospital mortality is not associated with either of the two contracting models. Quality-adjusted life years (QALYs) totaled 1.6 over a 2-year follow-up. Discussion: It is evident that throughout the care cycle at the Center of Excellence for Acute Myocardial Infarction, there is added value for patients with the PGP model, as the costs are lower and health outcomes comparable to the fee-for-service model. Conclusions: The findings of this study underscore the importance of understanding the relationship between value-based healthcare, different healthcare payment models, and health outcomes in AMI patients.

David procedure has shown to be a low-risk perioperative procedure even in challenged scenarios cases, with favorable long-term outcomes and additional benefits linked to the avoidance of prosthetic valves, including freedom from anticoagulation and reintervention, reduced risk of thromboembolic complications and endocarditis. Furthermore, an aortic valve preservation program in Colombia confers probably specific advantages to our population, considering the sociodemographic factors of middle-income countries. A retrospective analysis was conducted on the clinical and perioperative results, as well as short-term follow-up data of patients who underwent David procedure at one clinical center from Colombia between November 2021 and June 2024. One hundred and three patients were treated, with a mean age of 60 years, of whom 82.3% were male. In most cases, the preoperative diagnosis was aortic root dilation, with 80% presenting severe aortic insufficiency. Also 11.6% were initially diagnosed with type A acute dissection. The 30-day mortality was 0.9%. There were no cases of perioperative myocardial infarction nor dialysis requirement. Other complications were atrial fibrillation in 29.13% and acute renal failure in 9.7%. Follow-up was completed in 97.08% of cases, with survival rates at one year of 99%. Freedom from reintervention, endocarditis, and freedom from anticoagulation at one year were 100%, 100%, and 67%, respectively. In our study, David procedure emerged as an effective procedure, offering potential benefits that could be particularly relevant in middle-income countries. Perioperative and follow-up outcomes were comparable to those reported in large series from high-income countries.

Introduction: Bactibilia frequently complicates biliary obstruction, especially in malignant cases with drainage, and is associated with antimicrobial resistance, thereby posing significant therapeutic challenges. This study characterized the microbiological and clinical profiles, antibiotic resistance patterns, and associated risk factors in patients undergoing hepatobiliary surgery in Colombia. Materials and Methods: We conducted a cross-sectional analytical study on 95 patients with positive bacterial cultures following surgery. The analysis included clinical and microbiological variables. For analytical purposes, patients were stratified into two groups: those with PBD and those without, allowing for the assessment of clinical and microbiological differences between the cohorts. We used chi-square tests, Student’s t-tests, Mann–Whitney tests, and logistic regression. Results: Of the 95 patients, 61.05% were men, with a median age of 67 years. Preoperative exposure to endoscopic retrograde cholangiopancreatography was significantly higher in patients with biliary pancreatitis (73.47%; p=0.001). Escherichia coli exhibited high resistance to ampicillin/sulbactam (74.29%) and ciprofloxacin (59.46%), while piperacillin/tazobactam (89.74%). Resistance to meropenem was notably associated with female sex (odds ratio [OR: 9.55; 95% confidence Interval [CI], 1.12–80.9; P=0.038) and longer ICU stay (OR: 1.12; 95% CI, 1.00–1.24; P=0.038). Discussion: This study reveals significant antibiotic resistance in E. coli and K. pneumoniae, especially in patients with preoperative biliary drainage. These findings highlight the importance of tailoring antibiotic prophylaxis based on preoperative cultures to effectively address antibiotic resistance in hepatobiliary surgery.

Introduction. Robotic orthopedic surgery was introduced in Colombia in late 2023, representing a major technological advancement in joint replacement surgery. This study aimed to describe the sociodemographic characteristics, perioperative variables, and clinical outcomes of the first 100 patients undergoing robot-assisted total hip and knee arthroplasty using the Mako® robotic arm system in a high-complexity institution in Colombia. Methodology. A cross-sectional study was conducted between December 2023 and July 2024, including the first 100 patients undergoing robot-assisted total hip and knee arthroplasty. Clinical and demographic variables were obtained from electronic medical records. Continuous variables were summarized using descriptive statistics, while categorical variables were reported as frequencies and percentages. Results. Among the 100 patients, 69% were women, with a median age of 72 years (IQR 66–78). Most procedures corresponded to primary tricompartmental total knee arthroplasty. Regional anesthesia was administered in 96% of patients, and 94% received postoperative opioids. Hemoglobin levels decreased from 13.2 g/dL to 11.7 g/dL (p<0.001). Discussion. The initial implementation of robot-assisted arthroplasty demonstrated favorable perioperative and postoperative outcomes, supporting the feasibility and safety of robotic orthopedic surgery in a middle-income country context. Conclusions. Robotic orthopedic surgery showed positive early clinical outcomes and may contribute to optimizing surgical precision and postoperative recovery in joint replacement procedures.