American Society of Hirudotherapy

Aeromonas septicemia after medicinal leech use following replantation of severed digits

Case report published in Am J Crit Care (2009)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Case reportSafety & Infection ControlAntimicrobial ResistanceLevine SM et al. · American journal of critical care, 2009

Abstract

Medicinal leeches are used to control venous congestion. Aeromonas in the leech gut are essential for digestion of blood. This case report describes a patient who had Aeromonas bacteremia develop after leeching. He had an injury to his hand that required replantation of his thumb. Following the surgery, leech therapy was started with ampicillin-sulbactam prophylaxis. Sepsis developed. Blood cultures were positive for Aeromonas that were resistant to ampicillin-sulbactam. The antibiotic was changed to ciprofloxacin on the basis of the sensitivity profile of the organisms. Cultures from the leech bathwater confirmed it as the source of the Aeromonas. Clinicians who use leech therapy must be aware that leeches can harbor Aeromonas species resistant to accepted prophylactic antibiotics and that sepsis may occur.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeCase ReportsJournal Article
Indexed MeSH termsAeromonasAnimalsAntibiotic ProphylaxisGram-Negative Bacterial InfectionsHirudo medicinalisHumansMaleMiddle AgedReplantationSepsisSurgical Wound InfectionThumb

Summary

Patient with thumb replantation receiving leech therapy and ampicillin-sulbactam prophylaxis developed Aeromonas bacteremia resistant to that antibiotic, requiring ciprofloxacin.

Why This Matters for Hirudotherapy

This case report describes a patient who developed Aeromonas bacteremia after medicinal leech therapy following thumb replantation; despite ampicillin-sulbactam prophylaxis the patient became septic, blood cultures grew Aeromonas resistant to that antibiotic, the regimen was switched to ciprofloxacin per sensitivities, and the leech bathwater was confirmed as the source. This is directly and importantly relevant to hirudotherapy safety: Aeromonas are gut symbionts essential to the leech's blood digestion, and the report documents how leech-associated infection can occur and can be resistant to commonly chosen prophylaxis, reinforcing the need for appropriate antibiotic selection and vigilance during leech therapy. Caveat: as a single case report it illustrates a recognized risk and a management lesson rather than quantifying infection rates or comparing prophylactic regimens.

Citation

Aeromonas septicemia after medicinal leech use following replantation of severed digits.

Levine SM et al. · American journal of critical care, 2009

DOI

Added to ASH library: May 27, 2026 · Site last updated: June 18, 2026

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.