title: [Infection with Aeromonas hydrophila after use of leeches (Hirudo medicinalis) in a free microvascular osteo-(myo-)cutaneous flap--suggestions for successful management].
abstract: Medical leeches (Hirudo medicinalis) are an important therapeutic option in the treatment of venous congestion of flaps. In a case report an infection with Aeromonas hydrophila of a free microvascular osteo-(myo)-cutaneous flap after leech application for venous congestion is described and the current literature reviewed. Infection associated with leech therapy is a documented complication of leech application, with reported incidences ranging from 2.4 to 20 %. In some cases an infection of the wound developed with Aeromonas hydrophila, a Gram-negative rod that lives symbiotically in the intestines of the leech. Because of the risk of graft loss, early diagnosis and immediate initiation of an empirical intravenous antibiotic therapy with Piperacillin/Tacobactam or a third or fourth generation cephalosporins are essential even before results for sensitivity testing are received. An alternative is a short-term preemptive therapy with Cotrimoxazol or Ciprofloxacin during leech application.
authors.affiliation: Abteilung für Plastische, Rekonstruktive und Asthetische Chirurgie, Klinik für Wiederherstellende Chirurgie, Universitätsspital Basel, Spitalstrasse 21, 4056 Basel, Switzerland.
authors.forename: D F
authors.initials: DF
authors.lastname: Kalbermatten
authors.forename: U M
authors.initials: UM
authors.lastname: Rieger
authors.forename: K
authors.initials: K
authors.lastname: Uike
authors.forename: P
authors.initials: P
authors.lastname: Erba
authors.forename: G
authors.initials: G
authors.lastname: Laifer
authors.forename: B
authors.initials: B
authors.lastname: Hintermann
authors.forename: G
authors.initials: G
authors.lastname: Pierer
mesh_terms: D000328:Adult; D016980:Aeromonas hydrophila; D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D005528:Foot / Q000000981:diagnostic imaging / Q000601:surgery*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000209:etiology*; D047709:Hirudo medicinalis; D006801:Humans; D024763:Leeching / Q000009:adverse effects*; D008297:Male; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000008:administration & dosage / Q000627:therapeutic use*; D011859:Radiography; D013524:Surgical Flaps; D000078142:Tazobactam; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D010397:Penicillanic Acid; D000078142:Tazobactam; D010878:Piperacillin