title: Medicinal leech therapy and Aeromonas spp. infection.
abstract: While the use of medicinal leech therapy (MLT) in reconstructive and orthopaedic surgery is widely described, post-operative complications related to leeches remain a major concern. Aeromonas spp. strains are involved in the majority of reported cases. As surgical success rate is directly impacted, an adapted antibiotic prophylaxis should be instituted in order to minimize these complications. We assessed pharmaceutical process, microbiological control and related infections in order to provide data and choose the appropriate antibiotherapy for patients requiring MLT. We report a clinical and microbiological study over a 24-month period. Clinical data were collected from patients' database, and microbiological analysis both on leeches' tank water and crushed leeches were performed to characterize isolated strains and their susceptibility to antibiotics. A total of 595 leeches were used to treat 28 patients (12 in plastic surgery and 16 in orthopaedic surgery), and three documented cases of post-operative infections were reported. Aeromonas spp. isolates yielded from 62 % of analyzed batches (75 % of Aeromonas veronii). Eighteen Aeromonas spp. isolates yielded from 23 water samples and three crushed leeches. Isolates were similar in tank and crushed leeches. Strains were susceptible to fluoroquinolones, sulfamethoxazole/trimethoprim, aminosides, and third-generation cephalosporins but resistant to amoxicillin/clavulanic acid and second-generation cephalosporins. According to collected data, routine tank water microbiological analyses are mandatory in order to identify leeches' batches containing resistant strains and to discard them. In this context, the surgeon is able to select an appropriated antibiotic prophylaxis in order to avoid MLT associated serious post-operative complications.
authors.affiliation: Pharmacy Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France. benjamin.verriere@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Verriere
authors.affiliation: Pharmacy Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Sabatier
authors.affiliation: Microbiology Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Carbonnelle
authors.affiliation: Microbiology Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France.
authors.forename: J L
authors.initials: JL
authors.lastname: Mainardi
authors.affiliation: Pharmacy Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Prognon
authors.affiliation: Reconstructive Surgery and Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Wales, UK.
authors.forename: I
authors.initials: I
authors.lastname: Whitaker
authors.affiliation: Reconstructive Surgery Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Lantieri
authors.affiliation: Reconstructive Surgery Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Hivelin
mesh_terms: D000333:Aeromonas / Q000187:drug effects; D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007865:Leeches; D024763:Leeching / Q000009:adverse effects* / Q000379:methods; D008297:Male; D011183:Postoperative Complications
chemical_list: D000900:Anti-Bacterial Agents