title: Prophylactic use of levofloxacin during medicinal leech therapy.
abstract: BACKGROUND
  Medicinal leech therapy is effective in establishing venous outflow in congested flaps and replants. However, its use is also associated with infections, especially from Aeromonas species. To prevent this nosocomial infection, levofloxacin has been established as prophylaxis during leech therapy in our hospital.
  
  
  OBJECTIVE
  To study the implementation rate of a guideline, to study the effect of levofloxacin on possible Aeromonas infections, and to evaluate the financial impact of this preventive measure.
  
  
  METHODS
  A retrospective analysis on all patients treated with Hirudo medicinalis between July 2007 and March 2011 was performed at the Ghent University Hospital, Belgium.
  
  
  METHODS
  A list of patients treated with leeches was retrieved from the pharmacy database. Patient characteristics, date of start and stop of leech therapy were collected. Data on routine diagnostic cultures during leech therapy, date and type of clinical sample, while cultivated micro-organism with antibiotic susceptibility were obtained from the laboratory database.
  
  
  METHODS
  percentage implementation rate of a guideline, presence of Aeromonas infections, financial impact of levofloxacin prophylaxis.
  
  
  RESULTS
  Fifty-one patients were treated with leeches. Forty-six (90.2 %) patients were treated according the guideline. Fourteen out of 51 patients (27.5 %) were suspected for postoperative wound infections. From them, 60 clinical samples were sent for microbiological analysis. These included exudates (26.7 %), peroperative samples (5.0 %), puncture fluid (1.7 %), blood cultures (3.3 %) or smears from burns (63.3 %). No Aeromonas species were cultivated. Comparison between period before and after implementation of levofloxacin prophylaxis revealed that levofloxacin prevents colonization or infection with Aeromonas species in relation to leech therapy. The direct cost for levofloxacin prophylaxis in the current study was 2,570 euro. Based on data obtained in a previous study, we presume that a minimum cost-saving of 20,500 euro was realised during the current study period by implementation of antimicrobial prophylaxis.
  
  
  CONCLUSIONS
  This study demonstrates successful implementation of a guideline for levofloxacin prophylaxis during leech therapy. Following its introduction, no Aeromonas species related to the use of leeches were isolated as compared to 8.5 % in the baseline period.
authors.affiliation: Department of Pharmacy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium, tiene.bauters@uzgent.be.
authors.forename: Tiene
authors.initials: T
authors.lastname: Bauters
authors.forename: Franky
authors.initials: F
authors.lastname: Buyle
authors.forename: Stijn
authors.initials: S
authors.lastname: Blot
authors.forename: Hugo
authors.initials: H
authors.lastname: Robays
authors.forename: Dirk
authors.initials: D
authors.lastname: Vogelaers
authors.forename: Koen
authors.initials: K
authors.lastname: Van Landuyt
authors.forename: Wim
authors.initials: W
authors.lastname: Vanhove
authors.forename: Geert
authors.initials: G
authors.lastname: Claeys
mesh_terms: D000293:Adolescent; D000328:Adult; D000333:Aeromonas / Q000187:drug effects*; D000900:Anti-Bacterial Agents / Q000191:economics / Q000494:pharmacology*; D019072:Antibiotic Prophylaxis / Q000191:economics / Q000706:statistics & numerical data; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000191:economics / Q000517:prevention & control*; D019983:Guideline Adherence / Q000191:economics; D006801:Humans; D024763:Leeching / Q000009:adverse effects*; D064704:Levofloxacin / Q000191:economics / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin
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