In a 9-month cluster randomized trial conducted in 20 medical and surgical intensive care units (ICUs) and involving 26 180 patients, Harris and colleagues assessed whether required wearing of gloves and gowns for all patient contact decreased acquisition of antibiotic-resistant bacteria. The authors report that compared with usual care, universal glove and gown use did not lower rates of methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus acquisition. In an Editorial, Malani discusses strategies to prevent ICU infections.
Author Video Interview
Among patients with diabetes and multivessel coronary artery disease, coronary artery bypass graft (CABG) surgery is associated with lower rates of death and myocardial infarction than percutaneous coronary intervention (PCI) using drug-eluting stents. To determine whether there is a differential effect on patients’ ratings of their postoperative health status and quality of life, Abdallah and colleagues analyzed data from 1880 patients who were randomly assigned to undergo either CABG surgery or PCI using drug-eluting stents. The authors found that CABG surgery was associated with slightly better—but potentially clinically insignificant—intermediate-term health status and quality of life scores.
Critical illness is associated with significant skeletal muscle wasting. To characterize the process of muscle loss in critical illness, Puthucheary and colleagues performed serial ultrasound measurement of the rectus femoris in 63 patients and in a subset of patients assessed muscle fiber cross-sectional area and rates of muscle protein synthesis and breakdown in biopsy samples. Among the authors’ findings were that muscle wasting was rapid during the first week of critical illness and was more severe among patients with multiorgan failure. In an Editorial, Batt and colleagues discuss functional and molecular correlates of muscle loss in critical illness.
Metoclopramide is often prescribed for nausea and vomiting in pregnancy. To assess the safety of metoclopramide use during pregnancy, Pasternak and colleagues analyzed Danish registry data from 1.2 million pregnancies, among which 45 002 had exposure to metoclopramide. The authors report that metoclopramide use in pregnancy was not associated with increased risk of major congenital malformations overall or with any of 20 individual malformation categories assessed, spontaneous abortion, or stillbirth.
Asymptomatic internal carotid artery stenosis is common in older patients, but optimal management is unclear. Beckman discusses the evidence relating to the risk of stroke in patients with asymptomatic carotid artery stenosis, the effect of medical therapy on stroke risk, and risks and benefits of revascularization by carotid endarterectomy or carotid artery stenting.
Continuing Medical Education
Several observational studies suggest that the sexual partner of a patient infected with human immunodeficiency virus (HIV) is less likely to become infected if the patient is taking antiretroviral therapy (ART). In this JAMA Clinical Evidence Synopsis, Anglemyer and colleagues report results of an analysis of data from 9 observational studies (49 083 couples) and 1 randomized trial (1763 couples) that compared ART-treated with untreated HIV-serodiscordant couples. The authors found a lower risk of HIV transmission to the uninfected partner when the HIV-infected member of the couple received ART.
Highlights. JAMA. 2013;310(15):1527–1529. doi:10.1001/jama.2013.5364