American Society of Hirudotherapy

Infections following the application of leeches: two case reports and review of the literature

Maetz B, Abbou R, Andreoletti JB, Bruant-Rodier C (2012) · Journal of Medical Case Reports · n=2

RCT evidence detailTrial reference
GRADE Very LowInsufficient evidenceCondition: Breast Reconstruction Flap Salvage →
Sample size of this trial compared with other Breast Reconstruction Flap Salvage trialsRajaram R 202428Maetz B 20122Freeman M 20151Moffat AD 20151Torresetti M 20241Baccarani A 20221
This trial (highlighted) by sample size alongside other indexed Breast Reconstruction Flap Salvage trials. Larger trials generally carry more statistical weight.

Study Profile

Design
two-case report with literature review (Hôpitaux Universitaires de Strasbourg)
Sample size (n)
2
Intervention
Leech therapy applied to congested transverse rectus abdominis myocutaneous (TRAM) flaps for delayed mammary reconstruction in two women (ages 55 and 56) with subsequent Aeromonas veronii biovar sobria septicemia
Comparator
Historical leech-treated TRAM cohort without sepsis (literature)
Primary endpoint
Sepsis occurrence, microbiologic identification, antibiotic responsiveness
Primary result
Both patients developed Aeromonas veronii biovar sobria septicemia (day 6 and day 7 postoperative); both responded to 4 days of antibiotic treatment; amoxicillin/clavulanic acid resistance documented; sensitivity to third-generation cephalosporins and fluoroquinolones
Follow-up duration
Hospitalization through fever resolution
PMID
23098279

Key Findings

  • A. veronii biovar sobria identified as leech-associated pathogen (not A. hydrophila)
  • Septicemia at day 6-7 postoperative in both cases
  • Amoxicillin/clavulanic acid resistance documented
  • Sensitivity to third-generation cephalosporins and fluoroquinolones
  • Supports oral fluoroquinolone prophylaxis throughout leech treatment

Limitations

  • Only 2 cases - hypothesis-generating
  • Cannot quantify infection incidence rate
  • Aeromonas concentration reportedly decreases with antibiotic exposure
  • Antibiotic sensitivity patterns evolving
  • Single institution experience

Clinical Implications

Maetz 2012 expands the leech-associated infection profile beyond Aeromonas hydrophila to include A. veronii biovar sobria. For US clinicians under K040187, this case report reinforces the importance of fluoroquinolone prophylaxis throughout leech therapy duration and the need to consider broad-spectrum coverage for late-onset (day 6-7) sepsis. Updates antibiotic resistance profile relevant for protocol design.

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Compromised breast flap treated with leech therapy, hyperbaric oxygen, pentoxifylline and topical nitroglycerin: A case report

Moffat AD, Weaver LK, Tettelbach WH (2015)

Infection following Leech Therapy for the Treatment of Nipple-Areola Complex Congestion after Breast Reduction: A Case Report

Torresetti M, Peltristo B, Taddei FMJ, Di Benedetto G (2024)

The Use of Medicinal Leeching in Breast Surgery: A Systematic Review

Rajaram R, Cevik J, Bhindi N, Seth I, Rozen WM (2024)

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This website provides educational information and does not constitute medical advice, diagnosis, or treatment recommendations. Medicinal leech therapy carries clinically meaningful risks and should be performed only by qualified clinicians under institutionally approved protocols. FDA 510(k) clearance for medicinal leeches is limited to specific indications; investigational and off-label discussions are labeled accordingly. For patient-specific guidance, consult a qualified healthcare provider.