title: Maggots as potential vector for pathogen transmission and consequences for infection control in waste management.
abstract: OBJECTIVE
  Debridement therapy with sterile bred larvae in non-healing wounds is a widely accepted safe and efficient treatment modality. However, during application in the contaminated wound bed microbial contamination with potential microbial pathogen spread after escape from the wound or after unreliable disposal procedure may happen, particularly in the case of not using bio-bags. The aims of this work were first to investigate the release of ingested bacteria into the environment by maggots and second to examine the common practice of freezing the maggots after use and/or disposal in trash-bags. Potential methods for hygienic safe disposal of used maggots should be deduced.
  
  
  METHODS
  First, Maggots were contaminated with S. aureus by allowing them to crawl over an agar surface completely covered with bacterial growth over 24 h at 37°C. After external disinfection maggots were transferred onto sterile Columbia agar plates and shedding of S. aureus was visualized. Second, maggots were frozen at -20°C for 1, 2, 5, 10, 30, and 60 min. After exposure, the larvae were transferred onto Columbia blood agar with consecutive incubation at 37°C over 48 h. The larvae were analyzed visually for mobility and eating activities. The frozen bodies of dead larvae were examined for viable bacteria.
  
  
  RESULTS
  We could demonstrate that maggots release formerly ingested pathogens (S. aureus). Freezing at -20°C for at least 60 min was able to kill all maggots, however the contaminant bacteria inside could survive.
  
  
  CONCLUSIONS
  Since freezing is apparently able to kill maggots but not to reliabely inactivate the ingested bacterial pathogens, we recommend the disposal of free-range larvae in screw cap vials after use to achieve full hygienic control.
authors.affiliation: Clinic of Dermatology, University Medicine, Ernst-Moritz-Arndt University Greifswald, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Daeschlein
authors.affiliation: Department of Trauma and Orthopedic Surgery, Clinic of Surgery, University Medicine, Ernst-Moritz-Arndt University Greifswald, Germany.
authors.forename: Kevin
authors.initials: K
authors.lastname: Reese
authors.affiliation: Department of Trauma and Orthopedic Surgery, Clinic of Surgery, University Medicine, Ernst-Moritz-Arndt University Greifswald, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Napp
authors.affiliation: Department of Trauma and Orthopedic Surgery, Clinic of Surgery, University Medicine, Ernst-Moritz-Arndt University Greifswald, Germany.
authors.forename: Romy
authors.initials: R
authors.lastname: Spitzmueller
authors.affiliation: Department of Trauma and Orthopedic Surgery, Clinic of Surgery, University Medicine, Ernst-Moritz-Arndt University Greifswald, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Hinz
authors.affiliation: Clinic of Dermatology, University Medicine, Ernst-Moritz-Arndt University Greifswald, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Juenger
authors.affiliation: Institute of Hygiene and Environmental Medicine, University Medicine, Ernst-Moritz-Arndt University Greifswald, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Kramer
keywords: Lucilia sericata; antisepsis; biosurgery; disinfection; disposal of larvae; larval disinfection; maggot therapy