title: Infections following the application of leeches: two case reports and review of the literature.
abstract: BACKGROUND
  Since the 1980s, leeches have been ingeniously used in the management of venous flap congestion. The presence of anticoagulative substances in their saliva improves the blood drainage. Their digestive tract contains several bacterial species, the main ones being Aeromonas hydrophila and Aeromonas veronii biovar sobria, which contribute to the digestion of ingested blood. These bacteria can be the cause of infections.
  
  
  METHODS
  We report two cases of septicemia related to Aeromonas veronii biovar sobria that presented after leeches had been applied to congested transverse rectus abdominis myocutaneous flaps for delayed mammary reconstructions.Patient number 1 was a 55-year-old Caucasian woman who underwent a delayed breast reconstruction procedure. On the sixth postoperative day she showed a clinical presentation of septicemia. Aeromonas veronii biovar sobria was identified in the patient's skin and blood bacteriological samples. Her fever ceased after 4 days of antibiotic treatment.Patient number 2 was a 56-year-old Caucasian woman who underwent a delayed breast reconstruction procedure. On the seventh postoperative day we noticed that she showed a clinical presentation of septicemia. Aeromonas veronii biovar sobria was identified in the patient's blood cultures and local bacteriological samples. An antibiogram showed resistance to amoxicillin/clavulanic acid. Her fever ceased on the eleventh postoperative day after 4 days of antibiotic treatment.
  
  
  CONCLUSIONS
  The rate of infection after application of leeches is not negligible. The concentration of Aeromonas inside the digestive tracts of leeches largely decreases when the patient is under antibiotic therapy. These germs are sensitive to third-generation cephalosporins and fluoroquinolones and resistant to amoxicillin/clavulanic acid. We recommend preventive treatment based on classical measures of asepsis and on oral antibioprophylaxy with a fluoroquinolone during the whole period of treatment by leeches.
authors.affiliation: Department of Plastic and Maxillo-facial Surgery, Hôpitaux Universitaires de Strasbourg, 1, Place de l'Hôpital, Strasbourg Cedex, 67091, France. ben.maetz@wanadoo.fr.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Maetz
authors.forename: Ralph
authors.initials: R
authors.lastname: Abbou
authors.forename: Jean Baptiste
authors.initials: JB
authors.lastname: Andreoletti
authors.forename: Catherine
authors.initials: C
authors.lastname: Bruant-Rodier