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Algorithm-Based Therapy for Staphylococcal Bacteremia
Undertreated infections have lower cure rates, but overtreatment with antibiotics increases the likelihood of drug-related adverse events. Holland and colleagues for the Staphylococcal Bacteremia investigators randomized 509 patients with staphylococcal bacteremia and found that use of an algorithm to guide testing and treatment resulted in a noninferior rate of clinical success compared with usual care. In an Editorial, Perencevich and Malani suggest that antimicrobial stewardship programs and guidelines should consider the use of algorithms to set targets for the duration of antibiotic regimens.
Long-term Outcomes of Antibiotic Therapy for Appendicitis
Antimicrobial therapy is effective for the treatment of uncomplicated acute appendicitis, but the long-term recurrence rate is unknown. Salminen and colleagues followed 256 patients with appendicitis treated with antibiotics and found that the likelihood of appendicitis recurrence within 5 years was 39.1%. In an Editorial, Livingston suggests that patients with uncomplicated acute appendicitis should have the option to choose antibiotic therapy or undergo appendectomy if they do not want to worry about recurrence.
Author Audio Interview, Summary Video, and CME
Variant Reclassification Following Cancer Genetic Testing
The interpretation of genetic test results may change as new information about the risks of genetic variants becomes available. Mersch and colleagues assessed initial and amended test results for 1.45 million individuals who had hereditary cancer genetic testing at a single commercial laboratory and found that 24.9% of variants of uncertain significance were reclassified to categories of greater or lesser risk of pathogenicity. In an Editorial, Burke recommends that genetic test results should be interpreted in the context of other clinical information and the evolving understanding of genetic risks.
Clinical Review & Education
Fractional Flow Reserve to Assess Coronary Artery Stenosis
Coronary angiograms can overestimate or underestimate the severity of moderate stenosis. This JAMA Insights article by Bhatt discusses the strengths and limitations of measuring fractional flow reserve during angiography to guide therapeutic decisions.
Reconstruction After Breast Cancer Surgery
Breast reconstruction after mastectomy can improve physical and psychosocial well-being. This JAMA Insights article by Lee and Sheckter discusses techniques and outcomes of breast reconstruction surgery.
High-Resolution Manometry for Persistent Esophageal Symptoms
This JAMA Diagnostic Test Interpretation article by Patel and colleagues presents a 22-year-old man with retrosternal burning, gastroesophageal reflux, and intermittent solid-food dysphagia while taking acid suppressive therapy. An esophageal high-resolution manometry study demonstrated absent esophageal peristalsis and a median integrated relaxation pressure of greater than 15 mm Hg. How would you interpret these test results?
Highlights. JAMA. 2018;320(12):1213–1215. doi:10.1001/jama.2017.12559
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