NEJM

𝘏. 𝘱𝘺𝘭𝘰𝘳𝘪 infection is an infectious disease, and treatment regimens should ideally be guided by antimicrobial-susceptibility testing whenever possible. 🔗 nej.md/4Bj3O58

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: nej.md/4Bj3O58

Case Record of the Massachusetts General Hospital (@MassGeneralNews): A 42-year-old pregnant woman presented to the labor and delivery triage unit of the hospital at 20 weeks’ gestation because of recurrent heavy vaginal bleeding. 🔗 nej.md/4yP8kGm

Macroscopic examination showed a post-trachelectomy gravid hysterectomy specimen (weighing 487 g) with an in situ placenta (measuring 8.5 cm by 7.4 cm) with greater than 90% adherence to the posterior endometrial surface (Panel A). On sectioning, the placenta invaded the myometrium predominantly in the posterior wall (to a depth of up to 0.3 cm in a 2.6-cm wall) and extended to the lower uterine segment (Panel B). On microscopic examination, there were areas with no decidua between the chorionic villi of the placenta and the myometrium, a finding consistent with placental invasion (Panels C and D). Grading of placenta accreta spectrum disorder is based on the extent of invasion and destruction of local tissues. Given the presence of placental invasion with preservation of more than 25% of the total myometrial wall thickness, the criteria were met for placenta accreta spectrum disorder of grade 1–2.

Learn more about the disorder and read more about the case in “A 42-Year-Old Pregnant Woman with Vaginal Hemorrhage,” a Case Record of the Massachusetts General Hospital, by M. Prabhu et al.: nej.md/4yP8kGm

Presented at #ScientificSessions26:

In patients with type 2 diabetes and high cardiovascular risk, a systolic blood-pressure target below 120 mm Hg did not result in fewer major cardiovascular events than a target below 140 mm Hg. Full OPTIMAL-DIABETES trial results: nej.md/3UZYKCy

@AHAScience

Presented at #ScientificSessions26:

In older adults with at least two chronic conditions and no known atherosclerotic cardiovascular disease, statin discontinuation was noninferior to continuation for a composite of myocardial infarction, stroke, or death at 2 years. Full STREAM trial results: nej.md/47U1X9N

@AHAScience

Presented at #ScientificSessions26:

In patients with previous ischemic stroke or transient ischemic attack, a systolic blood-pressure target below 120 mm Hg was associated with fewer major cardiovascular events than a target below 140 mm Hg. Full OPTIMAL-STROKE trial results: nej.md/3UasT1O

@AHAScience