The study, published in BMC Infectious Diseases, examined cardiovascular surgery patients treated between January 2023 and December 2024. The overall prevalence of nosocomial infection in this population was 12.27 percent, a figure that underscores how common these complications are in a surgical specialty where patients often undergo open-chest procedures, receive mechanical ventilation, and carry multiple comorbidities. Yet the headline number conceals a striking heterogeneity. When the researchers stratified patients by DRG, infection rates ranged from comparatively low figures in some groups to nearly four in ten patients in others.

The highest burden appeared in the coronary artery surgery group designated FC19, where 39.57 percent of patients acquired a nosocomial infection. Heart valve surgery, grouped under FB29, followed with a rate of 34.49 percent, while complicated operations on the great vessels, coded FE19, saw infections in 31.09 percent of cases. These are not marginal differences from the overall average; they represent subgroups in which roughly one in three patients experienced an infection during hospitalization, an order of magnitude that demands targeted rather than generic prevention strategies.

Methodologically, the study tackled a persistent challenge in health economics research: infected and uninfected patients differ systematically in ways that bias simple cost comparisons. Patients who develop infections tend to be sicker at baseline, undergo longer operations, and stay in intensive care longer before the infection even appears. To address this, the investigators employed propensity score matching or inverse probability of treatment weighting within each DRG subgroup, techniques that statistically balance the comparison groups on observed characteristics. This design allowed them to isolate the additional costs attributable to infection itself, rather than to the underlying severity of illness.

The microbiology added another layer of concern. Klebsiella pneumoniae emerged as the most common pathogen in the study population, a finding consistent with the growing global prominence of gram-negative organisms in hospital-acquired infections. The researchers also tracked drug-resistant threats within their framework, referencing carbapenem-resistant Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, and carbapenem-resistant Pseudomonas aeruginosa as categories of concern. The dominance of Klebsiella is particularly notable given the rising prevalence of extended-spectrum beta-lactamase-producing and carbapenem-resistant strains of this organism worldwide, which complicates empirical antibiotic choices and raises both treatment costs and clinical risk.

The dominant infection type was equally striking. Non-ventilator-associated lower respiratory tract infections accounted for 90.57 percent of nosocomial infections in the cohort. That such a large share of infections involved the lower airways without being attributable to ventilator use points to a distinct pathophysiological and operational problem. Cardiac surgery patients arrive in the postoperative period with anesthesia-related respiratory depression, pain-limited coughing, immobility, and often preexisting pulmonary compromise, all of which create fertile conditions for pneumonia even after ventilators are removed. Prevention efforts aimed solely at ventilator bundles may therefore miss the bulk of the respiratory infection burden in this population.

The economic analysis quantified what those infections cost. Among patients in the heart valve surgery group FB29, a non-ventilator-associated lower respiratory tract infection significantly increased total hospitalization costs, with a cost ratio of 1.17, meaning infected patients incurred costs roughly 17 percent higher than statistically comparable uninfected peers, at a confidence interval of 1.01 to 1.36 and a P value of 0.037. More consistent effects appeared in the medicine cost category. Infections raised medication expenses by 50 percent in the FB29 valve surgery group, 27 percent in the FE19 great vessel group, and 30 percent in the FC19 coronary artery group, with all confidence intervals excluding unity and P values below 0.05.

One of the study’s most important conclusions is that the primary drivers of infection-attributable expenses differed across DRG groups. In some groups the excess costs flowed through pharmaceutical spending, reflecting prolonged or escalated antibiotic therapy and supportive medications. In others, longer intensive care stays, additional diagnostic testing, or extended ward admissions played larger roles in inflating total hospitalization costs. This granularity matters because it tells hospital administrators and infection-control teams not just that infections are expensive, but where in the cost structure those expenses accumulate for each category of cardiac operation.

The DRG lens is central to the study’s relevance for health policy. Under DRG-based payment systems, hospitals receive a fixed, prospectively determined payment per case grouped by diagnosis and procedure complexity. When a patient acquires an infection and costs rise, much of the additional expense is absorbed by the hospital rather than reimbursed, converting preventable infections from a payer problem into a direct institutional financial liability. The study’s findings suggest that hospitals performing high volumes of valve surgery, coronary artery procedures, or great vessel operations face particularly concentrated exposure, and that infection prevention in these DRGs functions as economic self-protection as much as clinical stewardship.

The authors conclude that further research is urgently needed to identify clinically recognizable, infection-related risk factors specific to each DRG, work that would enable precise infection management and better-informed resource allocation. In the interim, the study offers a template: rather than treating all cardiac surgical patients as a single population, hospitals can use DRG stratification to identify which procedure groups carry the highest infection risk, which pathogens dominate, and which cost categories bear the brunt of each preventable infection. As diagnostic-related group payment systems spread globally, that kind of subgroup-specific evidence is likely to become the standard against which infection-control investment is judged.

Subject of Research: Economic burden of nosocomial infections in cardiovascular surgery patients analyzed by DRG payment groups

Article Title: Direct economic burden of nosocomial infection in cardiovascular surgery patients based on DRG payment management

Article References: Wang, Y., Song, X., Jin, M., & Dong, Q. (2026). Direct economic burden of nosocomial infection in cardiovascular surgery patients based on DRG payment management. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14448-3

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14448-3

Keywords: nosocomial infection, cardiovascular surgery, diagnosis-related groups, lower respiratory tract infection, hospital costs, Klebsiella pneumoniae, health economics, cardiac surgery, infection control, DRG payment, hospital-acquired pneumonia, cost ratio

Candida auris is a yeast species first identified in Japan in 2009 and has since spread to dozens of countries, earning a place on public health watchlists because of its unusual combination of traits. Unlike most Candida species, it persists on skin and hospital surfaces for weeks, resists routine disinfection, spreads between patients in intensive care units, and frequently shows reduced susceptibility to the antifungal drugs that clinicians rely on. Compounding the problem, the organism is notoriously difficult to identify in the laboratory: conventional biochemical methods often misidentify it as Candida haemulonii or other related species, which means accurate detection typically requires matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, known as MALDI-TOF MS, or molecular sequencing. Misidentification delays both appropriate treatment and the infection control measures needed to contain outbreaks.

The Palestinian study included 36 patients with laboratory-confirmed C. auris infection treated at the tertiary care hospital. The mean age of the cohort was 54 years, with a standard deviation of 19.9 years, and 69 percent of the patients were female. The overwhelming majority, 89 percent, required intensive care unit admission, and their median ICU stay was strikingly long at 32 days, with an interquartile range of 18 to 58 days. This prolonged critical care exposure reflects both the severity of the underlying illnesses that predispose patients to invasive fungal infection and the persistent, difficult-to-eradicate nature of C. auris itself, which can colonize patients for weeks and complicate every subsequent hospitalization.

The researchers documented the invasive medical devices that characterize this patient population and that serve as classic gateways for fungal entry. Central venous catheters were present in 81 percent of patients, urinary catheters in 75 percent, and mechanical ventilation in 72 percent. These figures align with the international understanding of C. auris as a pathogen that exploits breaches in natural barriers and indwelling hardware in critically ill patients. The anatomical distribution of infection mirrored this device burden: the urinary tract was involved in 56 percent of cases, the respiratory tract in 50 percent, the bloodstream in 33 percent, and wounds in 17 percent, with some patients harboring the organism at multiple sites simultaneously.

The clinical trajectory of these infections was severe. Septic shock, the life-threatening circulatory collapse that represents the most extreme manifestation of sepsis, developed in 89 percent of the cohort. This extraordinary rate underscores how C. auris infection tends to emerge in patients already fighting for their lives, often superimposed on bacterial infections, organ failure, and prolonged ventilatory support. Distinguishing the specific contribution of the fungus to a patient’s deterioration from that of their underlying condition remains one of the central diagnostic challenges in invasive candidiasis, and the high septic shock rate in this cohort illustrates the grim context in which these infections typically declare themselves.

Treatment patterns revealed notable prescribing choices that the authors flag as potential stewardship targets. Definitive antifungal therapy consisted of azoles in 50 percent of patients, amphotericin B in 44 percent, and echinocandins in only 14 percent. This distribution is significant because international treatment guidelines generally recommend echinocandins, such as anidulafungin, caspofungin, or micafungin, as first-line agents for invasive Candida infections, including C. auris, due to their favorable efficacy and safety profile. The comparatively low echinocandin use and the prominent reliance on azoles, a class to which many C. auris strains exhibit reduced susceptibility, raise questions about antifungal stewardship practices, drug availability, cost constraints, and local susceptibility patterns that the authors suggest warrant further investigation.

The central outcome of the study was stark: all-cause in-hospital mortality reached 50 percent. On univariate analysis using Fisher’s exact test, two factors emerged as more frequent among non-survivors. Respiratory tract isolation of C. auris carried a crude odds ratio of 8.2, with a 95 percent confidence interval of 1.4 to 47.3 and a p-value of 0.008, while septic shock was also significantly associated with death, with a p-value of 0.034. The wide confidence interval around the odds ratio reflects the small sample size and the inherent imprecision of estimates drawn from 36 patients. The authors are careful to emphasize that these are exploratory, hypothesis-generating findings and should not be interpreted as independent predictors or causal relationships, since univariate comparisons cannot disentangle confounding factors such as illness severity, mechanical ventilation, or concurrent bacteremia.

From a methodological standpoint, the study followed the Strengthening the Reporting of Observational Studies in Epidemiology, or STROBE, framework and received ethical approval from the An-Najah National University Institutional Review Board, with a waiver of informed consent granted because of the retrospective design and the use of de-identified data. Laboratory confirmation relied on the hospital’s microbiology diagnostics, and susceptibility considerations were framed in terms of minimum inhibitory concentrations as defined by the Clinical and Laboratory Standards Institute. The retrospective cohort design, while efficient for characterizing a rare and recently emerged pathogen, carries limitations including reliance on documentation quality, the absence of a comparison group, and the possibility that some C. auris isolates were colonization rather than true infection, a distinction that even experienced clinicians find difficult in this population.

The significance of this work extends beyond a single institution. C. auris has been reported across the Middle East and globally, but granular clinical data from many regional health systems remain sparse, and this cohort provides a rare quantitative window into how the pathogen behaves in a tertiary hospital serving the Palestinian population. The 50 percent mortality figure sits within, though at the higher end of, the range reported in international literature, where mortality for invasive C. auris infection often falls between 30 and 60 percent depending on the population and the proportion of bloodstream infections. The heavy representation of urinary and respiratory tract isolates in this cohort, rather than predominantly bloodstream infection, may reflect local diagnostic and sampling practices as well as the patient mix.

The authors conclude that prospective, multicenter studies are needed to confirm these observations, define risk factors with adequate statistical power, and inform evidence-based antifungal stewardship and infection control policies in the region. In the meantime, the study delivers a clear message for clinicians and hospital epidemiologists: C. auris is established in this healthcare setting, it strikes patients who are already among the most vulnerable, and survival depends on early laboratory detection, judicious device management, rapid escalation to appropriate antifungal therapy, and rigorous adherence to the contact precautions and environmental disinfection protocols that are the only proven tools for interrupting its transmission within hospitals. As this pathogen continues its global expansion, cohorts like this one from previously underrepresented settings will be essential for building the collective evidence base needed to confront it.

Subject of Research: Clinical characteristics and in-hospital mortality of Candida auris infection in a Palestinian tertiary hospital cohort

Article Title: Candida auris infection in a palestinian tertiary hospital: 36-patient retrospective cohort with high mortality

Article References: Abutaha, M., Hattab, S., dweik, H., Mlitat, A., Najjar, N., Ayesh, B., Taha, A. A., & Sabatin, A. (2026). Candida auris infection in a palestinian tertiary hospital: 36-patient retrospective cohort with high mortality. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14648-x

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14648-x

Keywords: Candida auris, fungal infection, antimicrobial resistance, in-hospital mortality, intensive care unit, septic shock, antifungal stewardship, Palestine, retrospective cohort, nosocomial infection, echinocandins, infection control

The research team, led by Fatemeh Sameni and Masoud Dadashi with colleagues at institutions including Shahid Beheshti University of Medical Sciences and Alborz University of Medical Sciences in Iran, conducted a systematic literature search across three major databases: Medline via PubMed, Embase, and Web of Science. They targeted studies published between January 2000 and December 2025, casting a wide net over a quarter century of clinical research. To be included, studies had to report the prevalence of hospital-acquired infections in human populations and provide sufficient demographic and microbiological data. Two independent reviewers screened titles, abstracts, and full texts, extracted the relevant data, and assessed study quality using the Joanna Briggs Institute checklist, a standardized tool for appraising the methodological rigor of prevalence studies.

One of the most statistically important findings concerns the limits of the analysis itself. The overall observed prevalence of 15.72 percent could not be formally pooled into a single meta-analytic estimate because the underlying studies were extraordinarily heterogeneous, with an I² statistic of 99 percent. In practical terms, this means the variation between studies was almost entirely due to real differences in settings, methods, and populations rather than random chance, so averaging them into one number would be misleading. The authors were transparent about this constraint, presenting the observed prevalence while cautioning readers against overinterpreting it as a universal figure. This kind of statistical honesty is increasingly valued in evidence synthesis, where the temptation to produce a single headline number often obscures the messier truth.

What the data do show clearly is a stark geographic gradient. The highest prevalence figures were reported in Asia, at 43.04 percent, and Africa, at 34.07 percent, while India exhibited the highest national prevalence at 24.28 percent. These figures reflect the conditions under which the contributing studies were conducted, including the types of hospitals, the patient populations, and the surveillance methods used, but they align with a well-documented pattern: healthcare systems with fewer resources for hand hygiene, sterile equipment, isolation facilities, and laboratory diagnostics tend to report higher rates of infections acquired within their walls. In intensive care units, where patients are immunocompromised, invasively monitored, and exposed to multiple devices, the risks multiply.

The microbiological cast of characters behind these infections is dominated by a familiar lineup of opportunistic pathogens. The most frequently identified organisms were Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii. Each of these species has earned a fearsome reputation in clinical microbiology. S. aureus colonizes skin and nasal passages and is a leading cause of surgical site and bloodstream infections. E. coli drives catheter-associated urinary tract infections. P. aeruginosa thrives in moist hospital environments and attacks ventilated patients. K. pneumoniae and A. baumannii have become notorious for their capacity to acquire resistance genes and spread within hospital wards, with A. baumannii in particular emerging as a poster pathogen for the antimicrobial resistance crisis in conflict zones and intensive care settings.

The resistance data are where the review becomes genuinely alarming. Among 300 S. aureus isolates assessed for vancomycin susceptibility, 35 isolates, or 11.66 percent, were reported as vancomycin-resistant S. aureus, or VRSA. Vancomycin has long been the last-line treatment for serious methicillin-resistant S. aureus infections, so the emergence of strains that defeat it represents a clinical worst case. The authors are careful to note that this proportion reflects only the isolates evaluated in the contributing studies and should not be interpreted as the global prevalence of VRSA, a caveat that matters because the isolates tested were likely enriched for problematic strains. Even so, the finding underscores how far resistance to last-resort antibiotics has penetrated hospital ecosystems.

Beyond the staphylococci, the review catalogued the broader vocabulary of multidrug resistance that now defines hospital infectious diseases: methicillin-resistant S. aureus, vancomycin-resistant enterococci, carbapenem-resistant Enterobacteriaceae, and extended-spectrum beta-lactamase producing Gram-negative bacilli. Multidrug-resistant organisms complicate patient management worldwide because each resistant infection demands longer hospitalization, more toxic and expensive second-line drugs, and often leaves clinicians with few or no effective options. The authors also acknowledged a significant data gap: due to insufficient and inconsistent reporting across the included studies, resistance to colistin, itself a last-resort antibiotic for carbapenem-resistant Gram-negative infections, could not be comprehensively evaluated. That blind spot is itself a warning about the state of global surveillance.

In terms of infection types, respiratory tract infections, urinary tract infections, and surgical site infections emerged as the most common categories of hospital-acquired infection, particularly among patients admitted to intensive care units. This distribution maps directly onto modern critical care practice. Mechanical ventilation bypasses the natural defenses of the airway, urinary catheters provide a highway for bacteria into the bladder, and surgery creates wounds that pathogens can colonize. The review’s terminology reflects the standard epidemiological categories: central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonia, and surgical site infections, each with its own prevention bundle of evidence-based interventions such as hand hygiene, chlorhexidine bathing, subglottic suctioning, and early device removal.

The methodological machinery behind the review is worth appreciating. The authors followed PRISMA, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the international standard for transparent evidence synthesis. Pathogen identification across the included studies relied on techniques ranging from conventional culture and biochemical testing to matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, a rapid proteomic method that has revolutionized clinical microbiology, while susceptibility testing followed standards set by the Clinical and Laboratory Standards Institute and the European Committee on Antimicrobial Susceptibility Testing. The heterogeneity that prevented meta-analysis is a common feature of prevalence reviews spanning diverse countries and decades, but it also highlights the need for standardized surveillance definitions so that data from different settings can be meaningfully compared.

The conclusions the authors draw are directed squarely at policymakers and hospital leaders. Strengthening infection prevention and control measures, expanding antimicrobial stewardship programs, and building robust global surveillance systems are described as essential to reducing the burden of hospital-acquired infections and improving patient outcomes. Antimicrobial stewardship, the coordinated effort to prescribe antibiotics only when needed and at the right dose and duration, preserves the effectiveness of existing drugs while new ones are developed. Surveillance, meanwhile, is the foundation of any response: without knowing which pathogens are circulating and which drugs still work, clinicians are prescribing blind. As multidrug-resistant organisms continue to spread, the review serves as both a comprehensive baseline and a call to action, reminding the global health community that the fight against hospital infections is won or lost at the bedside, one hand wash, one catheter, and one prescription at a time.

Subject of Research: Global prevalence, microbial etiology, and antimicrobial resistance patterns of hospital-acquired infections

Article Title: Global prevalence, pathogens, and antimicrobial resistance patterns in hospital-acquired infections: a systematic review

Article References: Sameni, F., Kazemi, K., Bayat, S., Gharab, S. G., Firoozeh, F., Yadegarynia, D., Goudarzi, M., & Dadashi, M. (2026). Global prevalence, pathogens, and antimicrobial resistance patterns in hospital-acquired infections: a systematic review. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14614-7

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14614-7

Keywords: hospital-acquired infections, nosocomial infection, antimicrobial resistance, multidrug resistance, Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, intensive care unit, systematic review, infection prevention and control

Non-fermenting Gram-negative bacilli, abbreviated NFGNB, are a heterogeneous group of bacteria that do not ferment glucose and thrive in moist hospital environments. The two most clinically important members are Pseudomonas aeruginosa and the Acinetobacter calcoaceticus-baumannii complex, both of which have climbed the World Health Organization’s priority lists for antibiotic research because they increasingly shrug off nearly every drug in the formulary. In the Agartala cohort, Pseudomonas aeruginosa dominated, accounting for 88.3 percent of the isolates, while the Acinetobacter calcoaceticus-baumannii complex made up the remaining 11.7 percent. Soft tissue infections, which range from superficial wound infections to deep, life-threatening involvement of fascia and muscle, represent a particularly dangerous niche for these organisms because damaged tissue provides an entry point and local blood supply may be compromised.

The central therapeutic problem examined in the study is the loss of two critical drug classes. Carbapenems, once considered the reliable last line of defense against Gram-negative infections, are rendered ineffective when bacteria produce metallo-beta-lactamases, or MBLs, enzymes that use a zinc ion at their active site to hydrolyze the beta-lactam ring common to penicillins, cephalosporins, and carbapenems alike. When carbapenems fail, clinicians often turn to colistin, a polymyxin antibiotic so toxic to the kidneys that it was largely abandoned in the 1970s and then revived as a drug of last resort. Colistin resistance, in turn, can be mediated by mcr genes, mobile genetic elements that modify the lipopolysaccharide of the bacterial outer membrane so that the drug can no longer bind. The prospect of bacteria carrying both mechanisms simultaneously is what keeps infection control specialists awake at night, because it effectively removes the final pharmacological safety net.

To quantify the scale of the problem, the researchers first used the combined disk test, a phenotypic assay in which carbapenem disks are placed on bacterial lawns with and without a chelating agent such as EDTA that strips zinc from metallo-beta-lactamases. If the inhibition zone around the disk expands in the presence of the chelator, the enzyme is identified as an MBL. This screening identified MBL production in 25 of the Pseudomonas aeruginosa isolates and 13 of the Acinetobacter calcoaceticus-baumannii complex isolates. The team then confirmed and characterized the resistance at the molecular level using PCR to detect three major MBL gene families: blaNDM, blaIMP, and blaVIM. Among the isolates carrying MBL genes, blaNDM, which encodes the New Delhi metallo-beta-lactamase, was clearly predominant, consistent with the gene’s well-documented dominance across the Indian subcontinent and its global dissemination through travel and medical tourism.

On the colistin front, the picture was equally concerning. Resistance to colistin was observed in 19.5 percent of the Acinetobacter calcoaceticus-baumannii complex isolates, a substantial proportion given that colistin is frequently the only remaining option for these infections. The researchers screened for the full panel of known mobile colistin resistance genes, mcr-1 through mcr-9, using PCR. The most alarming finding was the detection of two strains harboring both blaNDM and mcr-3 simultaneously, meaning these bacteria could destroy carbapenems with a metallo-enzyme and block colistin binding with an MCR-3 modified cell surface. The mcr-3 gene is particularly interesting from an evolutionary standpoint because, unlike the more widely studied mcr-1 which originated in Escherichia coli from livestock, mcr-3 has been documented in diverse bacterial species and environments, and recent work has suggested that the MCR-3 enzyme may even help bacteria evade host phagocytosis, adding a virulence dimension to its resistance role.

Detecting resistance genes is only half the story; understanding how resistant strains move through a hospital is equally important for stopping them. For this, the team turned to ERIC-PCR, enterobacterial repetitive intergenic consensus polymerase chain reaction, a genomic fingerprinting technique that amplifies DNA regions between repetitive elements scattered across bacterial chromosomes. Because the spacing and number of these elements vary between strains, the resulting banding patterns serve as a rapid, low-cost proxy for genetic relatedness. The researchers analyzed the banding profiles using GelJ software and constructed phylogenetic trees with MEGA11 to visualize which isolates were likely clonal descendants of a common ancestor.

The fingerprinting results revealed clonal dissemination within the hospital, with genetically related isolates clustering particularly in the surgery and burn wards. This is epidemiologically significant because burn patients and surgical patients share predictable risk factors: breached skin barriers, prolonged hospital stays, indwelling devices, and heavy exposure to broad-spectrum antibiotics that select for resistant organisms. When a single clone establishes itself in such a ward, standard cleaning and hand hygiene failures allow it to colonize successive patients. Notably, the clustered isolates mostly shared cluster-specific resistance patterns, meaning that members of the same genetic lineage carried the same resistance gene profile. This concordance between genotype and resistance phenotype suggests that resistance determinants are being inherited vertically along with the clone itself rather than acquired independently by unrelated strains, which strengthens the case that transmission of whole organisms, not just horizontal gene transfer, is driving the observed pattern.

The co-occurrence of blaNDM and mcr-3 in the same strains deserves particular emphasis because it represents a convergence of two resistance mechanisms that were historically carried by different bacterial populations in different reservoirs. Carbapenem resistance has long been entrenched in hospital settings, while mcr genes were first identified in food animals and agricultural environments, raising fears that the agricultural and clinical reservoirs would eventually merge. The Agartala findings provide direct evidence that this convergence is happening in clinical isolates from soft tissue infections, not merely in surveillance studies of gut carriage. Each additional resistance mechanism stacked onto a circulating clone narrows the therapeutic window further; an infection caused by a strain producing NDM and carrying mcr-3 leaves clinicians with very few options, potentially including older, more toxic agents or combination therapies with limited evidence behind them.

The authors of the study, Ankan Chakrabarti, Tapan Majumdar, and Sibabrata Bhattacharya, frame their findings as a call for continuous molecular surveillance, rigorous hospital infection control, and stringent antibiotic stewardship. The seven-year prospective design strengthens the conclusions because it captures trends across time rather than a single snapshot, and the combination of phenotypic, molecular, and typing methods provides a layered picture of the resistance problem. The study was conducted with ethical approval from the institutional ethics committee and informed consent from participants, and the authors report no competing interests. While the data come from a single tertiary care center in Northeast India, the mechanisms documented there are not geographically confined; blaNDM and mcr genes travel readily through plasmids, transposons, and the international movement of patients.

For the broader scientific and public health community, the study underscores several practical lessons. First, soft tissue infections should not be overlooked as a reservoir of extreme drug resistance, since much surveillance attention focuses on bloodstream and respiratory isolates. Second, genotyping methods such as ERIC-PCR, despite being older and less granular than whole-genome sequencing, remain valuable tools for resource-limited laboratories to detect outbreaks early and trace transmission routes between wards. Third, the detection of mcr genes in Acinetobacter, an organism in which colistin resistance has more often been attributed to chromosomal mutations than to mobile genes, signals that mobile colistin resistance is expanding its host range among non-fermenting bacilli. As hospitals worldwide grapple with the post-antibiotic era, studies like this one from Agartala serve as an early warning: the bacteria that cause the most difficult infections are accumulating resistance determinants faster than new drugs are arriving, and the window for containment through surveillance, hygiene, and disciplined antibiotic use is narrowing with each clonal cluster identified.

Subject of Research: Genomic characterization of metallo-beta-lactamase and mcr-mediated resistance in non-fermenting Gram-negative bacilli from soft tissue infections

Article Title: Genomic characterization of non-fermenting gram-negative bacilli with metallo beta lactamase production and mcr based colistin resistance causing soft tissue infections: a seven-year hospital based prospective cross-sectional study

Article References: Chakrabarti, A., Majumdar, T., & Bhattacharya, S. (2026). Genomic characterization of non-fermenting gram-negative bacilli with metallo beta lactamase production and mcr based colistin resistance causing soft tissue infections: a seven-year hospital based prospective cross-sectional study. Molecular Biology Reports, 53(1), Article 1629. https://doi.org/10.1007/s11033-026-12802-x

Image Credits: AI Generated

DOI: 10.1007/s11033-026-12802-x

Keywords: antimicrobial resistance, metallo-beta-lactamase, NDM, mcr genes, colistin resistance, Pseudomonas aeruginosa, Acinetobacter baumannii, soft tissue infections, ERIC-PCR, nosocomial infection, carbapenem resistance, hospital surveillance

The research, led by Lintang Dian Saraswati of Queensland University of Technology and Diponegoro University, together with colleagues in Australia and Indonesia, focused on the Collaborative Framework for the Care and Control of Tuberculosis and Diabetes, a strategy Indonesia adopted in 2015. Detailed standard operating procedures followed in 2021, specifying that people with diabetes should receive chest X-ray screening for tuberculosis as part of their regular care. Yet little was known about how the patients themselves experience this screening, and that gap is precisely what the team set out to fill.

Between August and November 2023, the researchers conducted three focus group discussions involving eighteen participants and two in-depth interviews in Semarang City and Klaten District in Central Java. Participants were recruited purposively from both hospital and non-hospital settings, capturing perspectives from patients navigating different tiers of the Indonesian health system. Semi-structured guides with open-ended questions allowed respondents to describe their journeys through screening in their own terms, from the first referral slip to the moment the X-ray image was taken.

To make sense of the transcripts, the team applied a hybrid deductive-inductive thematic analysis anchored in the Health Belief Model, a classic psychological framework that explains health behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy. This approach let the researchers test whether the model’s constructs emerged in patients’ accounts while remaining open to themes the framework did not predict. The result is a layered map of the psychological and practical terrain a diabetic patient must cross before an X-ray actually happens.

The study’s central finding is that personal health beliefs and interpersonal support are the engine of participation. Patients who understood that diabetes silently raises their tuberculosis risk, and who felt encouraged by family members or trusted health workers, were far more willing to undergo screening. Cues to action, such as a nurse’s reminder or a relative’s insistence, often tipped the balance toward attendance. In the language of the Health Belief Model, perceived susceptibility and perceived benefit had to be activated by social reinforcement before they translated into behaviour.

Against those facilitators stood a cluster of structural barriers that no amount of personal motivation could easily overcome. Many participants had limited awareness of tuberculosis symptoms and, crucially, of the biological link between the two diseases, meaning they saw no reason to be screened when they felt well. Fear of nosocomial infection, the worry that visiting a clinic or hospital to prevent one disease might expose them to another, emerged as a particularly potent deterrent in the aftermath of a pandemic that made waiting rooms feel hazardous. Logistical challenges, including travel to facilities and time away from work, compounded the reluctance.

Financial concerns formed a second axis of inequity, but in a way that surprised the researchers. Indonesia’s Social Security Agency on Health, known as BPJS, covers the cost of screening for enrolled patients, dramatically reducing direct out-of-pocket expenditure. Yet participants described administrative and referral-related burdens that consumed time and patience: paperwork, queues, and the requirement to move through a hierarchy of first-level facilities before reaching secondary care. Paradoxically, the two self-funded participants in the study reported greater flexibility in accessing services, hopping directly to convenient providers, although the authors caution that these accounts should be interpreted as illustrative rather than representative, given the tiny number of such respondents.

The technical logic behind the programme is sound. Chest radiography can detect pulmonary tuberculosis in people who produce no sputum and report no cough, which is exactly the profile of many diabetic patients whose immune suppression blunts the classic symptoms of the disease. Systematic screening of this high-risk group is a cornerstone of the World Health Organization’s framework for collaborative tuberculosis-diabetes care, because every case caught early interrupts a transmission chain and prevents the catastrophic costs of late diagnosis. Indonesia’s 2021 standard operating procedure was designed to make such screening routine rather than opportunistic, embedding it in the chronic-care visits that diabetic patients already attend.

What the new study demonstrates is that a technically elegant procedure lives or dies at the level of human experience. A patient who fears the clinic, cannot decode the referral system, or does not grasp why an asymptomatic person needs a lung image will simply not arrive, no matter how sophisticated the radiography equipment waiting for them. The authors argue that health systems should therefore launch targeted educational campaigns that address two specific gaps: the risk posed by asymptomatic tuberculosis in diabetic patients, and the exaggerated fear of catching infection inside health facilities. They further recommend streamlining bureaucratic referral processes so that coverage on paper translates into equitable access in practice.

The findings carry weight far beyond Central Java. The twin epidemics of tuberculosis and diabetes intersect across South Asia, Southeast Asia and sub-Saharan Africa, and collaborative screening programmes are being rolled out in many of the same high-burden settings. By grounding programme evaluation in patients’ perspectives rather than administrative statistics, the study offers a template for implementation science: identify the beliefs that motivate, the fears that paralyse, and the paperwork that exhausts, then redesign the pathway around them. For Indonesia’s national programme, the message is clear. The X-ray machines are in place and the insurance coverage exists; the remaining task is to make the journey to the screening table feel safe, understandable and worth every patient’s time.

Subject of Research: Patient perspectives on chest X-ray tuberculosis screening within Indonesia's collaborative tuberculosis-diabetes programme

Article Title: Barrier and facilitator for chest X-ray tuberculosis-diabetes mellitus (CXR TB-DM) programme from patient’s perspective: a qualitative study

Article References: Saraswati, L. D., Pardosi, J. F., Widjanarko, B., & Gatton, M. L. (2026). Barrier and facilitator for chest X-ray tuberculosis-diabetes mellitus (CXR TB-DM) programme from patient’s perspective: a qualitative study. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14427-8

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14427-8

Keywords: tuberculosis, diabetes mellitus, chest X-ray screening, Indonesia, health belief model, qualitative research, BPJS, nosocomial infection, health systems, patient barriers, Central Java, public health