title: The role of leech water sampling in choice of prophylactic antibiotics in medical leech therapy.
abstract: Medical leech therapy (MLT) with Hirudo medicinalis is well established as a treatment for venous congestion of tissue flaps, grafts, and replants. Unfortunately, this treatment is associated with surgical site infections with bacterial species, most commonly Aeromonas hydrophila, which is an obligate symbiot of H. medicinalis. For this reason, prophylactic antibiotics are recommended in the setting of MLT. After culturing Aeromonashydrophila resistant to ciprofloxacin from a tissue specimen from a patient with a failed replant of three digits post-MLT, we performed environmental surveillance cultures and antibiotic susceptibility testing on water collected from leech tanks. This surveillance was performed twice weekly for 2.5 months. Fourteen surveillance cultures demonstrated 21 isolates of Aeromonas species, 71.4% of which were ciprofloxacin susceptible. All isolates were sulfamethoxazole-trimethoprim (SXT) susceptible. The prophylactic antibiotic regimen of choice for leech therapy at our institution is SXT, with culture of tank water to refine antimicrobial choice if necessary. This study demonstrates the importance of regular surveillance to detect resistant Aeromonas species in medical leeches; however optimal practice has not been established.
authors: Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
authors: Amanda
authors: A
authors: Wilmer
authors: Karen
authors: K
authors: Slater
authors: Judy
authors: J
authors: Yip
authors: Nicholas
authors: N
authors: Carr
authors: Jennifer
authors: J
authors: Grant
mesh_terms: D016980:Aeromonas hydrophila / Q000187:drug effects / Q000302:isolation & purification*; D000673:Amputation, Traumatic / Q000601:surgery; D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002939:Ciprofloxacin / Q000494:pharmacology / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D005383:Finger Injuries / Q000601:surgery; D005385:Fingers / Q000601:surgery; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D047709:Hirudo medicinalis / Q000382:microbiology; D006801:Humans; D017053:Infection Control / Q000379:methods; D024763:Leeching / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008826:Microbial Sensitivity Tests; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D012092:Replantation; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination