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[Correspondence] Global health equity and diagnosis of sepsis in low-income and middle-income countries

We read with great interest the Comment by Peter Hyland and colleagues in The Lancet Microbe on the crucial issue of the unaffordable cost of blood cultures for individuals in low-income and middle-income countries (LMICs).1 Further to their analysis, we would like to add that most patients in LMICs cannot afford the cost of US$5–7 per blood culture bottle or the cost of antimicrobial susceptibility testing, which for automated systems can be an additional $15–20 per blood culture sample.1

[Correspondence] Early warning alert and response system for Darfur, Sudan

2 years have passed since the escalation of the conflict in Sudan on April 15, 2023, precipitating the world’s largest and fastest-growing displacement crisis.1,2 In this scenario, disease outbreaks are increasing in the face of disruptions to basic public health services, including vaccination, disease surveillance, public health laboratories, and rapid response teams.2–4 Resources to detect and respond to these outbreaks have been scarce, particularly in areas that are hard to reach such as the Darfur states.

[Correspondence] Heteroresistance and clinical outcomes: much still to be understood–Authors’ reply

We read with great interest the Correspondence by Gabriele Maria Leanza and colleagues and appreciate this opportunity to comment on the authors’ insights. As the authors noted, escalation of care and admission to intermediate care unit or intensive care unit are confounded metrics. In our study, we identified an association between breakpoint crossing heteroresistance (BCHR) and admission to higher levels of care.1 Our interpretation of this finding is that when the BCHR phenotype was missed by clinical laboratories, patients in our cohort appeared to have a higher risk of admission to intermediate care unit or intensive care unit.

[Correspondence] Heteroresistance and clinical outcomes: knowledge gaps

We read with interest the study published by Gabriel Heyman and colleagues in The Lancet Microbe,1 which retrospectively analysed 255 people with Escherichia coli bloodstream infections. The authors found that 109 (43%) of 255 E coli strains showed breakpoint-crossing heteroresistance (BCHR) for gentamicin and 22 (9%) of 255 strains for piperacillin–tazobactam. Although no correlation was observed between BCHR and length of hospital stay—the primary outcome—BCHR was associated with increased odds of intermediate or intensive care unit admission when patients received the antibiotic to which the strain was heteroresistant.

[Comment] Rethinking decolonisation for individuals with cancer: lessons from the emergence of meticillin-resistant Staphylococcus epidermidis in intensive care units

The Article by Sara Sharaf and colleagues in The Lancet Microbe challenges a cornerstone of modern infection control—universal chlorhexidine decolonisation—revealing an unintended consequence with profound implications for cancer care. Their finding that universal decolonisation in Scottish intensive care units (ICUs) paradoxically increased meticillin-resistant Staphylococcus epidermidis (MRSE) infections by selecting for multidrug-resistant strains should trigger immediate re-evaluation of decolonisation protocols in oncology settings.

[Comment] Breaking bacterial communication: the future of next-generation antibiotics

Antimicrobial resistance (AMR) has emerged as a crucial global health threat. By 2050, approximately 1·91 million deaths are forecasted to be directly attributable to AMR, with an estimated 8·22 million deaths associated with AMR.1 In their Review published in The Lancet Microbe, Ho and colleagues emphasised the urgency of developing novel antibacterial agents that operate through mechanisms distinct from those of conventional antibiotics. The authors also highlighted a spectrum of emerging non-antibiotic strategies designed to mitigate the escalating threat of AMR.

[Comment] Balancing individual and community risk: role of dentists in antimicrobial stewardship

Antimicrobial resistance (AMR) is a considerable and rapidly growing threat to global health and is estimated to cause 10 million deaths annually by 2050. Dentists are responsible for approximately 10% of all antibiotic prescriptions, with inappropriate antibiotic use estimated to occur in up to 80% of cases involving acute conditions and prophylaxis.1

[Comment] Impact of bacterial secondary resistome on antimicrobial susceptibility

Antimicrobial resistance (AMR) is a major global public health burden1 and is mediated through five principal mechanisms: reduced permeability, active efflux, target modification, drug inactivation, and target bypass.2 Each mechanism is primarily driven by specific resistance genes; however, the interplay between AMR determinants and other genetic elements within the bacterial genome remains poorly understood.

[Editorial] The CDC "is in trouble, and we need to fix it"

When taken in isolation, these words, spoken by US Department of Health and Human Services (HSS) Secretary Robert F Kennedy Jr in an interview on Fox News on Aug 28, are likely to be agreed upon by both his supporters and those who have been dismayed by his actions since he took office earlier this year. What will profoundly differ, however, are the views on the causes of the US Centers for Disease Control and Prevention (CDC)’s “trouble”, who the “we” taking charge of “fixing it” should be, and how such “fixing” should be undertaken.

[Viewpoint] A public health perspective on assisted dying and its different modalities

Assisted dying (encompassing euthanasia and assisted suicide) has emerged as a legally sanctioned option for end-of-life care in an increasing number of countries. Over 200 million people now live in jurisdictions permitting some form of assisted dying, with at least 12 countries having implemented national or subnational legislation as of May, 2025. Legal frameworks, terminology, and procedures remain highly heterogeneous, affecting how assisted dying is perceived, delivered, and monitored. Terminological variation and the absence of specific ICD codes impede international data comparability, limiting public health surveillance and cross-country learning.

[Health Policy] Comparing US prevention efforts to other high-income countries

Life expectancy in the USA is considerably lower than in most high-income countries, with many deaths considered preventable. The extent by which poor performance on prevention measures and public health policies in the USA could be contributing to this issue is not well understood. To address this issue, we compared publicly available population-based indicators of health care across different levels of prevention in the USA and six high-income countries (ie, Australia, Canada, Germany, France, Sweden, and the UK) and Organisation for Economic Co-operation and Development countries between 2010 and 2023.

[Articles] Investigating associations between long-term poverty exposure and premature mortality: evidence from the National Longitudinal Survey of Youth 1979 prospective cohort

Greater cumulative exposure to poverty across emerging and established adulthood is associated with a greater risk for premature mortality. To inform public health action and policy, future research should evaluate the effects of providing support to individuals who are experiencing financial hardships during these important life stages on health and longevity.

[Articles] The burden of bacterial antimicrobial resistance in the WHO Eastern Mediterranean Region 1990–2021: a cross-country systematic analysis with forecasts to 2050

Our study shows that bacterial AMR has been a serious public health threat in the EMR for more than 30 years, with a substantial fatal and non-fatal burden for priority bacterial pathogens and pathogen–drug combinations. The magnitude of this issue, future projects, and the inadequate response capacity in many countries underscore the need for more stringent regional leadership in this field. The insights gained from this study can direct targeted mitigation strategies for individual countries within the region, aiding in resource allocation and funding decisions, and emphasising the need for collaborative multisectoral endeavours among nations to address this issue.

[Articles] Cirrhosis incidence across socioeconomic and demographic groups in Sweden: a register-based cohort study

Cirrhosis incidence in Sweden is increasing and unequally distributed across income groups. These findings are likely to be relevant beyond Sweden, given similar trends in MASLD-related and ALD-related cirrhosis reported across other high-income countries. Targeted prevention and early detection are needed to reduce the growing burden, especially among socioeconomically disadvantaged populations.

[Articles] National roll-out of social prescribing in England's primary care system: a longitudinal observational study using Clinical Practice Research Datalink data

Social prescribing has expanded rapidly in England, far exceeding initial targets of 900 000 patients by 2023–24, suggesting broad service acceptability. Progress is being made in reaching specific target groups, such as more deprived communities. However, there are still disparities in accessibility and uptake, calling for targeted strategies to address underlying inequalities.