Antimicrobial prophylaxis during Hirudo medicinalis therapy: a multicenter study
Multicenter cohort study published in Journal of Reconstructive Microsurgery (2014)
Abstract
BACKGROUND: Medicinal leeches (Hirudo medicinalis) are indicated for salvage of tissue flaps, grafts, or replants when venous congestion threatens tissue viability. The purpose of this study was to evaluate the efficacy of prophylactic antimicrobial agents in patients who received medicinal leech therapy. MATERIALS AND METHODS: A multicenter retrospective cohort study of all adult patients between January 1, 2010, and February 28, 2013, who received medicinal leech therapy was conducted. RESULTS: Antimicrobial prophylaxis was documented in 54 (91.5%) of the included patients, ciprofloxacin, trimethoprim-sulfamethoxazole, piperacillin-tazobactam, and ceftriaxone in 33 (61.1%), 18 (33.3%), 2 (3.7%), and 2 (3.7%) patients, respectively. Surgical site infection (SSI) was found in seven (11.9%) patients, all of whom received antimicrobial prophylaxis. Aeromonas spp. was isolated in four infections, and all isolates were resistant to the chosen prophylactic agent. The SSI incidence was similar between antimicrobial prophylaxis agents. CONCLUSION: Trimethoprim-sulfamethoxazole and ciprofloxacin appear equally effective at preventing leech-associated infections.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Multicenter retrospective cohort of 54 leech-therapy patients found 11.9% surgical site infection rate despite prophylaxis; trimethoprim-sulfamethoxazole and ciprofloxacin were comparable but all Aeromonas isolates were resistant to the chosen agent.
Why This Matters for Hirudotherapy
This multicenter retrospective cohort study evaluated antimicrobial prophylaxis in 59 adult patients who received Hirudo medicinalis therapy between 2010 and 2013, with 91.5% receiving prophylaxis (ciprofloxacin 61.1%, trimethoprim-sulfamethoxazole 33.3%, piperacillin-tazobactam and ceftriaxone 3.7% each). Surgical site infection occurred in 11.9% of patients, all of whom had received prophylaxis; Aeromonas spp. was isolated in four infections, and all isolates were resistant to the chosen prophylactic agent. The SSI incidence was similar across prophylactic agents, leading the authors to conclude that trimethoprim-sulfamethoxazole and ciprofloxacin appear equally effective. These findings are directly relevant to hirudotherapy infection prevention. Limitations include the retrospective design, the relatively small cohort, and the finding that all documented Aeromonas infections involved resistance to the prophylactic agent used, suggesting current prophylaxis strategies remain imperfect.
Citation
Antimicrobial prophylaxis during Hirudo medicinalis therapy: a multicenter study.
Kruer RM, Barton CA, Roberti G, Gilbert B, McMillian WD · Journal of reconstructive microsurgery, 2014
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