[A revolutionary change in the recommendations for antimicrobial prophylaxis of infective endocarditis (ie)].

Prophylactic use of antibiotics to prevent infective endocarditis (IE) used to be a part of the routine care of patients with almost any type of cardiac abnormality for more than 50 years. However, in the absence of placebo-controlled, randomized, double-blinded studies to evaluate its efficacy, doubts have been raised concerning its utility. It was recently concluded that IE is much more likely to result from frequent exposure to random bacteremias associated with daily activities than from bacteremias caused by invasive medical procedures; that only a small number of cases of IE are caused by bacteremia that follows dental procedure; and that prophylaxis may prevent an extremely small number of cases of IE. This led the American Heart Association (AHA) to initiate substantial changes in the recommendations for prophylaxis, the main points of which are as follows: 1. Good oral hygiene and eradicating dental disease is the most important tool for preventing IE. 2. Antibiotic prophylaxis should be limited only to patients at high risk for complications and mortality from IE. 3. Prophylaxis for GI or GU tract procedures is no longer recommended. It is most likely that this remarkable change in the guidelines will provoke a debate in the medical literature; moreover, for the first time, this change allows performing placebo-controlled, randomized, double-blinded studies to evaluate the efficacy of antibiotic prophylaxis of IE.

Outbreak of adenovirus type 55 infection in Israel.

BACKGROUND: Different types of adenoviruses are associated with diverse diseases and with varied disease severity. Adenovirus 55 could be associated with severe respiratory infections. OBJECTIVES: Here, we report on an adenovirus 55 outbreak in two psychiatric institutions in Israel. The objective of this study was to investigate the adenovirus 55 outbreak. STUDY DESIGN: We studied the clinical parameters of the patients and sequencing analysis of certain parts of the virus gene was performed. RESULTS: We identified the first patient who developed symptoms (the index case) and we showed that while both patients and staff members of the institutions were infected, the disease in the psychiatric patients was more severe. We attributed these differences to their mental and underlying health conditions. CONCLUSIONS: It is important to monitor for adenovirus infection in the community, especially in mental health institutions to allow appropriate medical care.

Pseudallescheria boydii infection of a prosthetic hip joint--an uncommon infection in a rare location.

Pseudallescheria boydii infection of the hip joint was diagnosed 2.5 years after implantation of a prosthetic joint in a woman with rheumatoid arthritis. Cure was achieved with a 10-month course of voriconazole coupled with removal of the prosthesis and repeat surgical debridement. Pseudallescheria boydii is an environmental mold that can cause osteoarticular infection, most often not only after local trauma but also after local injections and surgical procedures. Hip involvement was rarely reported, and this is the first description of a prosthetic joint infection with Scedosporium sp.