A case of leech-associated infection involving an extended-spectrum β-lactamase-producing and extensively drug-resistant Aeromonas hydrophila

Floug, Q.; Sinna, R.; Fillatre, A.; Plésiat, Patrick; Hamdad, Farida

doi:10.1016/j.cmi.2018.11.006

Cited by 6 publications

(1 citation statement)

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“…Eleven of the 32 (34.4%) patients received a cotrimoxazole-uoroquinolone combination, and one patient (9%) carried an extensively drug-resistant, extended-spectrum β-lactamase-producing A. hydrophila strain. The fact that this same strain was isolated from the water in which the leeches were stored strongly that the patient had been infected by A. hydrophilacontaminated leeches (9). Thirteen of the 37 patients (35.1%) had a post-operative infection -mainly due to Aeromonas spp.…”

Section: Resultsmentioning

confidence: 98%

The Risk-Benefit Ratio of Leech Therapy: A Single-Center Retrospective Study

Fillatre

Floug

Assaf

et al. 2021

Preprint

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Background: Venous congestion in transplanted or replanted tissues remains a common and challenging complication of plastic and reconstructive surgery. The local application of medicinal leeches is effective in reducing postoperative venous congestion in skin flaps and restoring normal blood flow. However, leech therapy is associated with a number of risks, including infections; in order to digest blood, leeches have a symbiotic relationship with Aeromonas species in their gut. Aeromonas infections are associated with a dramatic decrease in flap salvage rates. This is why prophylactic antibiotic treatment and external decontamination of the leeches are widely recommended. Methods: We performed a single retrospective study of patients having undergone leech therapy between January 1st, 2010, and December 31st, 2018, at Amiens-Picardie University Hospital, France. Each patient’s medical history, clinical data, laboratory results, prophylactic antibiotic use, and complications were recorded.Results: A total of 37 patients (mean age: 47) had undergone leech therapy after reconstructive surgery. Antimicrobial prophylaxis was documented in 32 (84.6%) patients. However, there are no guidelines on the choice of prophylactic antibiotic treatment. Twenty-four of the 37 (64.8 %) patients had anemia (mean hemoglobin level: 8.5 (6-11.1) g/dL), and 13 of the 24 (54%) required a transfusion. Thirteen of the 37 patients (35.1%) had a post-operative infection mainly due to Aeromonas spp. (76.9%). Leech therapy was effective in 23 of the 37 patients (62%) overall and in 2 of the 10 patients (20%) with an Aeromonas infection. The association between Aeromonas infection and flap salvage failure was highly significant (p = 0.005).Conclusions: The results of the study emphasized that clinical bacteriologists and surgeons should be aware that leeches are potential sources of infection.

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Section: Resultsmentioning

confidence: 98%

The Risk-Benefit Ratio of Leech Therapy: A Single-Center Retrospective Study

Fillatre

Floug

Assaf

et al. 2021

Preprint

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Increasing multidrug resistance in leech borne infections. Should we adjust antibiotic treatment regime in plastic surgery? A systematic review

Wagner,

Ulrich

2024

Eur J Plast Surg

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Background A growing number of reports of serious wound infections during medical leech therapy over the last decades caused by the leech gut symbiont Aeromonas spp. led to the standard use of single antibiotics. With more published data about raising multidrug resistance of Aeromonas species in leech guts, there is probably a need for adjustment of existing treatment regimens. Methods We screened PubMed, Scopus, and Web of Science databases using relevant keywords including the last five decades addressing this issue. The review process was based on the PRISMA guidelines. Two independent reviewers screened the abstracts; extracted data were pooled and analyzed for antimicrobial resistance. Meta-analysis was not conducted, based on the poor quality of the included studies. Result A total of 43 studies were included in this review. All of the studies were reports or case series—except one—and the quality was combined overall good. Evidence was not found for using special antimicrobial agents as first line therapy. Conclusions Concluding this work, the survey revealed a growing number of more resistant or partially multi-resistant bacterial strains against different commonly used antibiotics, most probably based on increasing resistance in the environment. Taking these data into account, we advise combining leech therapy with minimal dual antibiotic drug administration with ciprofloxacin and co-trimoxazol in the first place and leech gut sampling before inset for antibiotic drug resistance monitoring, and increased awareness during and after leech therapy. Level of Evidence: Not ratable

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