Antimicrobial resistance may develop in nature including in hospital wastewater through horizontal genetic transfer. Few studies were conducted on the antimicrobial resistance genes in hospital wastewater and wastewater isolates in Indonesia. The prevalence and abundance of beta-lactam resistance genes in hospital wastewater and Enterobacterales wastewater isolates were investigated. Twelve wastewater samples were collected from an influent wastewater treatment plant. Escherichia coli and Klebsiella pneumoniae were isolated from the wastewater samples by culture-based methods. DNA was extracted from wastewater samples and the isolates. Nineteen beta-lactam resistance genes were tested by a high throughput qRT-PCR method. bla_GES and bla_TEM were the most abundant genes detected in hospital wastewater and Escherichia coli, respectively (p < 0.001). The relative abundance of bla_{CMY_2}, bla_CTX-M5, bla_CTX-M8, bla_GES, bla_NDM, and bla_SHV11 in Klebsiella pneumoniae was higher than in the wastewater and Escherichia coli (p < 0.001; p = 0.006; p = 0.012; p < 0.001; p = 0.005; p < 0.001). Klebsiella pneumoniae might be associated with resistance to piperacillin/tazobactam, ceftriaxone, and cefepime (p < 0.001; p = 0.001; p < 0.001). In conclusion, ESBL genes showed higher abundance than carbapenemase genes in hospital wastewater samples. The ESBL-producing bacteria that were predominantly found in hospital wastewater may originate from clinical specimens. The culture-independent antibiotic resistance monitoring system might be developed as an early warning system for the increasing beta-lactam resistance level in clinical settings.

Urosepsis is one of the most serious complications of percutaneous nephrolithotomy (PCNL). To date, many studies aim to prescreen urosepsis possibility after PCNL through blood components. This met...

HIV infection alters host immunity, including the oral environment, leading to microbial imbalance and increased risk of opportunistic infections. Although antiretroviral therapy (ART) improves immune function, its effect on the oral microbiome remains unclear, particularly in Indonesia. This study investigated oral microbiome composition in people living with HIV and its associations with ART status, age, and sex. In this cross-sectional study, oral rinse samples from 245 adults (115 HIV-on-ART, 15 HIV-ART-naïve, and 115 HIV-negative controls) were analysed using 16S rRNA gene sequencing. Alpha and beta diversity metrics, differential abundance (ANCOM-BC2), and multivariable associations (PERMANOVA) were assessed. The oral microbiome differed significantly between HIV-positive groups and controls (PERMANOVA p = 0.001, R² = 1.8%). HIV-ART-naïve individuals exhibited the highest alpha diversity and enrichment of pro-inflammatory genera, including Fusobacterium, Alloprevotella, and Staphylococcus. ART-treated individuals displayed a partial shift toward the control profile but retained persistent depletion of bacteria such as Filifactor and (Eubacterium) saphenum. Multivariate analysis identified HIV status, age, and sex as independent contributors to microbial variation. HIV infection is associated with a distinct oral dysbiosis characterised by an increase in opportunistic pathogens and reduction in commensal bacteria. HIV-on-ART individuals show a transitional shift towards the HIV-negative oral microbiome profiles. Our findings suggest that biological and/or demographic factors coupled to oral microbiome profiles may facilitate targeted interventions in the personalised management of oral health for individuals living with HIV.

Corneal ulcer is an infectious condition of the cornea that involves the epithelial layer to the stroma. Steroid use to treat corneal ulcer without indication is still a massive issue especially in primary-level healthcare facility (PLHF) and may potentially cause various complications. Steroids can delay epithelial healing and induce perforation, and also neutrophil inhibition that will lead to infection exacerbation. A holistic understanding of corneal ulcers, especially the approach to diagnosis, both clinically and diagnostics work up, and effective management for patients are very important to understand, especially in PLHF. This case report aims to provide knowledge regarding the  steroid management of corneal ulcers and periosteal graft use in perforated corneal ulcers. . Male, 39 year old, comes to RSUD Dr. Saiful Anwar Malang (RSSA) with chief complaints of redness, pain, and white lesion that progressively widened in left eye. Patient had a history of trauma caused by inflorescence one month ago. White lesion was first only a pinpoint lesion but progressively widened. Patient have sought medical advice to PLHF  and secondary-level healthcare facility (SLHF), then referred to  RSSA with potential complication occurring.  Approach to diagnosis holistically and management with correct indication is important to prevent corneal ulcer perforation especially due to steroid use.