American Society of Hirudotherapy

Ciprofloxacin-resistant Aeromonas infection following leech therapy for digit replantation: report of 2 cases

van Alphen NA, Gonzalez A, McKenna MC, McKenna TK, Carlsen BT, Moran SL (2014) · Journal of Hand Surgery · n=2

RCT evidence detailTrial reference
GRADE Very LowInsufficient evidenceInfections after leech therapy
Sample size of this trial compared with other Infections after leech therapy trialsDoğan S 2024570Kruer RM 201459Beka L 201837Brauer PR 202419Wilmer A 201314van Alphen NA 20142Reese K 20152Maetz B 20122Bibbo C 20132Torresetti M 20241
This trial (highlighted) by sample size alongside other indexed Infections after leech therapy trials. Larger trials generally carry more statistical weight.

Study Profile

Design
two-case report (Mayo Clinic Rochester, cases occurring within 4 months of each other)
Sample size (n)
2
Intervention
Leech therapy after unsuccessful digital replantation in patients with subsequent ciprofloxacin-resistant Aeromonas hydrophila infection
Comparator
Historical Mayo Clinic protocol with ciprofloxacin or TMP-SMX prophylaxis
Primary endpoint
Infection characteristics, antibiotic resistance patterns, and treatment outcomes
Primary result
Both cases successfully treated with ceftriaxone after failure of ciprofloxacin prophylaxis; documents emerging ciprofloxacin-resistant Aeromonas strains in replantation center setting
Follow-up duration
Infection resolution
PMID
24495623

Key Findings

  • Two ciprofloxacin-resistant Aeromonas cases within 4 months
  • Ceftriaxone successful as rescue antibiotic
  • Documents emerging resistance to first-line prophylaxis
  • Replantation centers should monitor local Aeromonas susceptibility
  • Antibiogram-guided prophylaxis selection recommended

Limitations

  • Only 2 cases - cannot quantify resistance prevalence
  • Single replantation center experience
  • Cannot determine if cases share common Aeromonas source
  • Limited microbiologic characterization of resistance mechanism
  • Cannot recommend universal protocol changes

Clinical Implications

van Alphen 2014 documents emerging ciprofloxacin-resistant Aeromonas at a major US replantation center, supporting periodic local antibiogram review and consideration of ceftriaxone as backup. For US clinicians under K040187, this Mayo Clinic case series reinforces antimicrobial stewardship principles and the dynamic nature of resistance profiles in leech-treated populations.

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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.