title: Antimicrobial prophylaxis during Hirudo medicinalis therapy: a multicenter study.
abstract: BACKGROUND
  Medicinal leeches (Hirudo medicinalis) are indicated for salvage of tissue flaps, grafts, or replants when venous congestion threatens tissue viability. The purpose of this study was to evaluate the efficacy of prophylactic antimicrobial agents in patients who received medicinal leech therapy.
  
  
  METHODS
  A multicenter retrospective cohort study of all adult patients between January 1, 2010, and February 28, 2013, who received medicinal leech therapy was conducted.
  
  
  RESULTS
  Antimicrobial prophylaxis was documented in 54 (91.5%) of the included patients, ciprofloxacin, trimethoprim-sulfamethoxazole, piperacillin-tazobactam, and ceftriaxone in 33 (61.1%), 18 (33.3%), 2 (3.7%), and 2 (3.7%) patients, respectively. Surgical site infection (SSI) was found in seven (11.9%) patients, all of whom received antimicrobial prophylaxis. Aeromonas spp. was isolated in four infections, and all isolates were resistant to the chosen prophylactic agent. The SSI incidence was similar between antimicrobial prophylaxis agents.
  
  
  CONCLUSIONS
  Trimethoprim-sulfamethoxazole and ciprofloxacin appear equally effective at preventing leech-associated infections.
authors.affiliation: Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Kruer
authors.affiliation: Department of Pharmacy, Oregon Health & Science University, Portland, Oregon.
authors.forename: Cassie A
authors.initials: CA
authors.lastname: Barton
authors.affiliation: Department of Pharmacy, Oregon Health & Science University, Portland, Oregon.
authors.forename: Gregory
authors.initials: G
authors.lastname: Roberti
authors.affiliation: University of Florida College of Pharmacy, Jacksonville, Florida.
authors.forename: Brian
authors.initials: B
authors.lastname: Gilbert
authors.affiliation: Department of Pharmacy Services, Fletcher Allen Health Care, Burlington, Vermont.
authors.forename: Wesley D
authors.initials: WD
authors.lastname: McMillian
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002939:Ciprofloxacin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D024763:Leeching; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination