NEJM✓

𝘏. 𝘱𝘺𝘭𝘰𝘳𝘪 infection is an infectious disease, and treatment regimens should ideally be guided by antimicrobial-susceptibility testing whenever possible. 🔗 Both phenotypic (culture-based) and molecular methods of antimicrobial-susceptibility testing are available (seen in figure). Culture-based testing remains the reference standard because it is the only method that can ascertain the susceptibility of isolates to all antibiotics commonly used for eradication. Molecular antimicrobial-susceptibility testing offers greater efficiency than culture-based testing by eliminating the need for 𝘏. 𝘱𝘺𝘭𝘰𝘳𝘪 culture. Molecular-based testing can be conducted with fresh or formalin-fixed gastric-tissue samples (used for histopathological examination) and successfully cultured isolates. More recently, gastric-fluid samples obtained from a swallowed gastric string have emerged as a cost-effective alternative culture-based testing method. Stool-based molecular antimicrobial-susceptibility testing is now available, which avoids invasive endoscopy. Commercial polymerase-chain-reaction–based kits are now available for identifying 𝘏. 𝘱𝘺𝘭𝘰𝘳𝘪 resistance to clarithromycin and levofloxacin by detecting specific mutations in the 𝘏. 𝘱𝘺𝘭𝘰𝘳𝘪 23S ribosomal RNA and gyrA genes, respectively. A meta-analysis reported high accuracy of these molecular methods for detecting antibiotic resistance in gastric-biopsy samples, with sensitivity and specificity of 96% and 96%, respectively, for clarithromycin resistance and 97% and 99% for quinolone resistance. Learn more in the Review Article “𝘏𝘦𝘭𝘪𝘤𝘰𝘣𝘢𝘤𝘵𝘦𝘳 𝘱𝘺𝘭𝘰𝘳𝘪 Infection — Advances, Challenges, and the Road Ahead” by Hong Li, MD, PhD, Francis Megraud, MD, and Barry J. Marshall, MD:

Images in Clinical Medicine: Tuberculous Empyema Resulting in Pseudochylothorax #Pulmonology #InfectiousDisease

RT @NEJMEvidence: Volume 5 Issue 11 of 𝘕𝘌𝘑𝘔 𝘌𝘷𝘪𝘥𝘦𝘯𝘤𝘦 is now available! Here is a preview of the latest content: 𝗣𝘂𝗯𝗹𝗶𝗰 𝗛𝗲𝗮𝗹𝘁𝗵 𝗔𝗹𝗲𝗿𝘁𝘀 Domestic Measles Importations in Washington State, January 2026

A new review summarizes the history of 𝘏. 𝘱𝘺𝘭𝘰𝘳𝘪 research, updates the understanding of the pathogenesis and global burden of the infection and the screening strategy for preventing gastric cancer, and focuses on the emerging trends in managing the infection. Full review:

Perspective by Nicole Huberfeld, JD, and Paul R. Shafer, PhD: Community Engagement Requirements in Medicaid — Law as a Determinant of Health #HealthPolicy #MedicalEthics

RT @NEJMClinician: A healthy 51-year-old has AFib and a CHA2DS2-VASc of 1. Should you start him on a DOAC? Rahul B. Ganatra, MD, MPH (@rbganatra), discusses the SINGLE-AF trial results that were recently published in @NEJM.

Tarlatamab–Durvalumab Maintenance for Extensive-Stage Small-Cell Lung Cancer (phase 3 DeLLphi-305 trial)

Divarasib as Compared with Sotorasib or Adagrasib in 𝘒𝘙𝘈𝘚 G12C–Mutated NSCLC (phase 3 Krascendo 1 trial)

Osimertinib–Savolitinib in Advanced NSCLC after Progression during EGFR-TKI Therapy (phase 3 SAFFRON trial)

Anbenitamab plus HB1801 for HER2-Positive Advanced Breast Cancer (phase 3 HEALER trial)

Durvalumab, Tremelimumab, and Enfortumab Vedotin in Muscle-Invasive Bladder Cancer (phase 3 VOLGA trial)

#ESMO26 Round Up: Six Original Articles were simultaneously published in NEJM and presented at this year’s European Society of Medical Oncology (@myESMO) Congress in Madrid.

Presented at ASRM 2026: In a trial involving couples with unexplained infertility, four cycles of intrauterine insemination with ovarian stimulation was not noninferior to one complete cycle of IVF with respect to the cumulative live-birth rate. Full FIIX trial results: @ASRM_org

RT @NEJM_AI: Perspective by P. Jarrett et al.: No Mastery without the Machine — Medical Education in the Age of Clinical AI #MedEd #AIinMedicine

RT @NEJMClinician: In an @NEJM Case Record, a 39-year-old man was admitted to the hospital with hypertension, abdominal pain, and foot drop. "...this case highlights two useful subtypes that clinicians should ingrain into memory," writes @ClementLeeMD. Read his full comment:

“We essentially are told to, by default, include age, sex and race into all of our models that accounts for the majority of population health differences.” Shazia Siddique, MD, MSHP, explains how the common belief that race is biological in nature is now being challenged on the grounds that race is instead socially constructed. Watch the full Perspective Roundtable:

Figure 4 from a new Review Article shows the algorithm for empirical 𝘏. 𝘱𝘺𝘭𝘰𝘳𝘪 treatment. Rifabutin-based triple therapy has been suggested as a first-line treatment option in the United States; however, it is generally reserved as a third-line rescue therapy. Learn more:

RT @NEJMEvidence: 𝐍𝐨𝐰 𝐚𝐯𝐚𝐢𝐥𝐚𝐛𝐥𝐞 𝐢𝐧 𝑵𝑬𝑱𝑴 𝑬𝒗𝒊𝒅𝒆𝒏𝒄𝒆! A new Public Health Alerts report, published in partnership with @CIDRAP: Colorectal Cancer among U.S. Adults, 2000–2023 #Oncology #Gastroenterology

Images in Clinical Medicine: Spinal Tuberculosis #Neurology #InfectiousDisease

Perspective by Lisa S. Rotenstein, MD, MBA, Nicholas Stine, MD, and Bruce Landon, MD, MBA: Why Shared-Savings ACOs Have Failed to Deliver for Primary Care #HealthPolicy #MedicalPractice