A 51-year-old previously fit and healthy gentleman sustained a circular saw injury to his right thumb with partial amputation and an open multifragmentary fracture of his distal phalanx. He underwent open reduction and internal fixation under the hand surgery team. He developed a postoperative infection discharging pus 2 weeks postoperatively, which later grewCandida parapsilosis. He underwent radical debridement and removal of a K-wire, then a further second debridement 2 days later. Ceftriaxone was started empirically while awaiting cultures. Tissue and bone biopsy samples obtained in theatre all grewC. parapsilosisand he was started on caspofungin for 1 week, and switched on to oral fluconazole to complete a 6-week course. He has progressed well and has regained function in his thumb after 3 months, without any sign of ongoing infection.

A 69-year-old man, previously independent and with a pre-existing metallic aortic valve, presented with a history of fevers, confusion and malaise and was diagnosed with prosthetic valve endocarditis. Blood cultures taken on presentation grewStreptococcus sanguinisand vegetations were confirmed on transoesophageal echocardiogram. He had had a dental procedure 10 days before presentation but had not received prophylactic antibiotics; he had been receiving antibiotic prophylaxis for dental treatment up until the change in NICE guidelines in 2008. He was treated with high dose antibiotics and was referred for cardiothoracic surgery, but developed a cerebrovascular event, thought to be embolic, and deteriorated and died. Given that the patient had a metallic aortic valve and poor dentition, and therefore was at increased risk of infective endocarditis, should the new guidelines have been followed so rigidly, particularly as American and European guidelines still recommend the use of antibiotic prophylaxis in this patient group?