BackgroundThe lack of procedure-specific, evidence-based dental antibiotic guidelines increases unnecessary and inappropriate antibiotic prescribing. The primary objective was to evaluate changes in antibiotic prescribing before and after antibiotic stewardship (AS) education by infectious diseases (ID) AS experts in addition to implementation of self-monitored antibiotic dashboards. A secondary objective was to link antibiotic prescriptions to standardized Current Dental Terminology (CDT) procedure codes.MethodsWe conducted a retrospective, multi-practice cohort study among 9 private practice periodontists who completed AS education by ID-AS experts. Antibiotic data, CDT codes, and medical histories were extracted from electronic dental records from 1 January 2021 through 30 June 2025. Individualized dashboards displayed longitudinal antibiotic prescribing and linkage to CDT procedure codes. Outcomes were compared across pre-education, post-education year 1, and post-education year 3 periods.ResultsA total of 11 795 antibiotic prescriptions for 7331 unique patients were identified; 85.6% were therapeutic (≥3 days) and 14.4% were prophylactic. Prophylactic antibiotics for patients with prosthetic joint implants decreased by 89% by post-education year 3 (P < .05). Clindamycin and fluoroquinolone use declined by 85% (P < .001) and 31% (P < .15), respectively. Ten-day antibiotic durations decreased by 87% (P < .001) with a corresponding increase in courses of 3–5 days across multiple CDT procedure categories. Improvements were sustained 3 years after education without ongoing external audit and feedback.ConclusionsDentists demonstrated sustained improvements in antibiotic use following ID-AS–led stewardship education and implementation of self-monitored antibiotic dashboards. Linking prescriptions to CDT codes supports future development of evidence-based dental antibiotic guidelines.

Evaluations of early exposure to the infectious diseases (ID) specialty typically focus on medical students and residents. Of 65 prehealth summer health professions program graduates surveyed, 21% showed at least fair interest in ID. Of 32 respondents interested in medicine, 10 considered internal medicine or pediatrics, which could lead to an ID career.

Enteric fever, caused by Salmonella Typhi or Paratyphi, is a major public health issue in low- and middle-income countries. Accurate burden estimation is hampered by limited microbiological facilities and low sensitivity of blood-culture tests. Serosurveillance offers a scalable alternative to address these challenges. This study estimated the seroincidence of enteric fever in Bangladesh using cross-sectional rapid serosurveys. School-based surveys (January-June 2022) were conducted in Chattogram, Dinajpur, Sylhet, Satkhira, and Faridpur, and community-based surveys (July 2019-November 2021) were conducted in Dhaka and Mirzapur. Blood samples (dried blood spots or venous blood) were collected and tested for anti-hemolysin E IgG responses using a kinetic enzyme-linked immunosorbent assay. Seroincidence was estimated using a maximum likelihood approach based on peak antibody titers and decay rates, modeled from blood-culture confirmed enteric fever cases in Bangladesh. A total of 2969 participants aged 0-22 years were enrolled, with 75.5% aged 5-15 years. Seroincidence rates (per 100 person-years) were highest in Dhaka (33.1; 95% confidence interval [CI], 29.0-37.9), followed by Mirzapur (19.5; 95% CI, 17.4-21.7) and Chattogram (17.1; 95% CI, 15.0-19.4), and the lowest in Faridpur (11.1; 95% CI, 9.6-12.7). The under 5 age group exhibited higher rates in Dhaka (40.3; 95% CI, 32.1-50.7) and Mirzapur (26.1; 95% CI, 21.0-32.4) compared to older age groups. Seroincidence was higher in areas with higher population density. This study highlights a substantial burden of enteric fever infections across Bangladesh. These provide important evidence to guide post-introduction monitoring and optimization of the typhoid conjugate vaccine program in the national immunization schedule.

Determining serotype-specific, age-stratified dengue virus (DENV) and Zika virus (ZIKV) seroprevalence rates is crucial for implementing vaccines and vector control strategies. Therefore, we sought to assess the age-stratified seroprevalence of monotypic or multitypic exposure in a community cohort in Sri Lanka. DENV-specific serostatus was assessed in 4161 children aged 4 to 16 years, using an in-house DENV-specific IgG enzyme-linked immunosorbent assay (ELISA), and results were compared with those of a widely used commercial assay (Panbio Dengue IgG Indirect ELISA). We also used a multiplexed, microsphere-based serological assay to characterize monotypic vs multitypic responses and to differentiate exposure rates to different DENV serotypes and ZIKV in a subcohort of children (n = 604). By IgG ELISA, DENV seropositivity was 72.34% (3010/4161), and the seropositivity rate significantly increased with age (Spearman r = 1.0, P = .003). The estimated force of infection was 0.16 (95% credible interval, 0.14-0.17). Of the 604 individuals tested by Luminex, 258 (42.7%) had a monotypic dengue response, whereas 209 (34.9%) had a multitypic response. Moreover, 100 (16.5%) had evidence of a past infection to Zika, while 20 (3.33%) children had antibodies only to ZIKV. Of the 258 individuals with evidence of a monotypic response to DENV, DENV2 (56.83%) and DENV1 (30.57%) accounted for the most infections. There was an inverse correlation between exposure to ZIKV and age (Spearman r = -0.72, P = .007). An overall 72.3% of children were seropositive for dengue, with 42.7% having been infected with only 1 DENV in the past. The data suggest that prior immunity to DENV may reduce the risk of ZIKV infection, which should be further assessed.

This study aimed to assess mpox virus (MPXV) seroprevalence in South Kivu, Democratic Republic of the Congo, where a large mpox outbreak started at the end of 2023. A community-based surveys was conducted in urban (April-May 2023) and rural (July-August 2024) areas and a multiplex serological assay to detect anti-IgG against MPXV has been used. MPXV seroprevalence was 3.3% in the urban survey (n = 1174) and 8.3% in the rural survey (n = 981), with differences according to health zone (P = .004) after the mpox outbreak. This study shows temporal and geographic variation in MPXV seroprevalence and suggest potential spread of mpox in the general population in South Kivu.

Antimicrobial susceptibility testing (AST) is the basis of directed antimicrobial therapy and stewardship. However, its interpretation frequently relies on rapid and intuitive judgment, rather than on deliberate analytical reasoning. Using Kahneman's dual-process theory of cognition, we argue that AST interpretation is particularly vulnerable to system 1 heuristic bias, especially in real clinical environments. Using illustrative examples from contemporary resistance scenarios, such as extended-spectrum β-lactamase-producing Enterobacterales and multidrug-resistant Pseudomonas aeruginosa, we discuss the evolving resistance patterns over years, and it has increased interpretive complexity beyond what categorical AST outputs alone convey. We propose that interpretative errors may often arise from predictable cognitive responses, rather than from insufficient knowledge, which may be reinforced by current laboratory reporting formats and clinical workflows. Finally, we discuss educational, structural, and reporting strategies to foster system 2 engagement and mechanism-aware interpretation, with implications for antimicrobial stewardship and the training of medical students and early-career clinicians.

Lower respiratory tract infections (LRTIs) are a leading cause of morbidity in older adults, yet risk stratification based solely on chronological age remains insufficient. Frailty, reflecting cumulative declines in physiological reserve, may better capture susceptibility to respiratory infections. We aimed to investigate the association of frailty with the risk and frequency of LRTIs in older adults. We conducted a multicenter prospective cohort study among older adults in senior living communities in China, from November 2023 to September 2025. Baseline frailty was evaluated using the clinical frailty scale. Participants were monitored for LRTIs throughout the follow-up period. The association between frailty and LRTI risk was evaluated using cause-specific Cox proportional hazards models, with subgroup and sensitivity analyses performed to assess the consistency and robustness of the findings. For the LRTI frequency analysis, Poisson generalized estimating equation models were applied. The cohort included 522 older adults with a median follow-up of 473.5 days. 104 LRTI episodes were documented, and 13.4% participants experienced at least one event. Frailty was a significant predictor of LRTI risk (adjusted HR, 1.29; 95% CI, 1.10-1.52), which remained robust across different LRTI types and sensitivity analyses. This association was particularly pronounced in participants with albumin levels < 45 g/L. Beyond initial infection risk, frailty was also associated with an increased frequency of LRTIs (adjusted incidence rate ratio, 1.30; 95% CI, 1.09-1.54). Frailty constitutes an independent and modifiable risk factor for LRTIs in older adults, emphasizing the importance of frailty management in LRTI preventive strategies.

Human papillomavirus (HPV), a major cause of cervical cancer, typically remains localized to the cervix. However, there is limited understanding of whether this localized infection is associated with systemic immune responses in asymptomatic women, beyond the immediate cervical microenvironment. This study aimed to assess whether systemic immune-inflammation markers are linked to HPV infection and HPV-related cytological abnormalities in asymptomatic women undergoing health screening. This cross-sectional study included women from the Kangbuk Samsung Health Study who underwent HPV DNA testing and cervical cytology between 2016 and 2022. Participants were categorized as H0C0 (HPV-negative and normal cytology), H1C0 (HPV-positive and normal cytology), and H1C1 (HPV-positive and abnormal cytology, defined as low-grade abnormalities, including atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions). Systemic immune-inflammation markers, including white blood cell-derived indices, high-sensitivity C-reactive protein, systemic inflammation response index (SIRI), lymphocyte-to-monocyte ratio (LMR), and neutrophil-to-monocyte ratio (NMR), were analyzed. Multinomial logistic regression was used to estimate the odds ratios (ORs) by biomarker quintiles and per 1-standard deviation (SD) increase. Among 145 889 women (mean age 40.4 years), 6535 were classified as H1C0 and 2820 were classified as H1C1. Individuals with higher monocyte counts (Q5 vs Q1) had a significantly higher risk of H1C0 (OR = 1.14, 95% confidence interval [CI]: 1.06-1.24) and H1C1 (OR = 1.22, 95% CI: 1.08-1.37). Similarly, SIRI was positively associated with HPV infection status, with increasing odds for both H1C0 and H1C1 compared with H0C0, whereas LMR and NMR were inversely associated with H1C1. Per 1-SD increase, LMR was inversely associated with both H1C0 (OR = 0.71, 95% CI: 0.59-0.87) and H1C1 (OR = 0.48, 95% CI: 0.35-0.65), while monocyte count showed a positive association. Human papillomavirus infection was associated with systemic immune-inflammatory changes, most notably elevated monocyte count and related indices, even in individuals without cytological abnormalities. These findings highlight the potential relevance of monocyte-related markers for capturing the systemic immune effects of HPV infection beyond localized cervical changes.