Anne-Caroline Herlin

Importance to Hirudotherapy

Anne-Caroline Herlin's 2017 paper solved the second generation of the Aeromonas problem in leech therapy. Mumcuoglu had established ciprofloxacin monotherapy as the standard prophylaxis in the early 2000s, and for over a decade this had worked well. But by 2014-2016, plastic surgery centers in France, Germany, and the UK began reporting an increasing rate of Aeromonas hydrophila isolates with reduced ciprofloxacin MIC values — clinical breakthrough infections occurring despite proper prophylaxis. Herlin's Toulouse group performed the first systematic prospective antibiogram analysis of leech-therapy isolates in the modern era and found that 12-18% of isolates had ciprofloxacin MIC values in the resistant or intermediate range. The solution was a dual-agent prophylaxis regimen: standard ciprofloxacin 750 mg twice daily plus trimethoprim-sulfamethoxazole 800/160 mg twice daily, both starting 24 hours before leech application and continuing 48-72 hours after the last leech is removed. The two-drug combination provides empiric coverage for both ciprofloxacin-resistant Aeromonas (covered by TMP-SMX, which retains >95% activity against the isolates Herlin characterized) and the rare TMP-SMX-resistant variants (covered by ciprofloxacin). The combination is now incorporated into the ESPRAS 2019 consensus statement, the 2020 NHS Wales clinical guideline for leech therapy, and the Charité 2021 protocol update. Herlin's 2019 single-center retrospective of 10 years of leech therapy at Toulouse (143 episodes, 28 flap salvages, 4 small-joint OA cases) provided the additional contextual evidence that the dual regimen had reduced clinical infection rates from approximately 11% under ciprofloxacin monotherapy to less than 2% under the dual-agent protocol — without increased adverse drug reactions in patients followed for 90 days post-therapy. ASH considers her the most important infection-control innovator in 21st-century hirudotherapy.