American Society of Hirudotherapy

Ceftriaxone-Resistant Aeromonas hydrophila Infection Following Leech Therapy: A New Resistant Strain

Case report published in Annals of Plastic Surgery (2018)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Case reportSafety & Infection ControlBykowski MR, Zhu X, Diaz-Garcia R · Annals of plastic surgery, 2018

Abstract

We report a case of ceftriaxone-resistant Aeromonas hydrophila infection in a 32-year-old man after medicinal leech therapy. The patient underwent a free gracilis muscle flap for dorsal foot soft tissue reconstruction. Because of persistent congestion after venous revision, medicinal leech therapy was initiated to aid in flap salvage. Intravenous ceftriaxone was administered prior to application of leeches for prophylaxis against A. hydrophila. Leech therapy was discontinued after 1 week, and ceftriaxone was discontinued 24 hours thereafter. An infection developed despite being on appropriate antibiotics. Culture sensitivities indicated that A. hydrophila was resistant to ceftriaxone.

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

Publication typeCase ReportsJournal Article
Indexed MeSH termsAdultAeromonas hydrophilaAnti-Bacterial AgentsCeftriaxoneDrug Resistance, BacterialGram-Negative Bacterial InfectionsHumansLeechingMaleMicrobial Sensitivity Tests

Summary

First report of ceftriaxone-resistant Aeromonas hydrophila infection developing in a free gracilis flap patient despite ceftriaxone prophylaxis, expanding the spectrum of leech-associated resistant pathogens.

Why This Matters for Hirudotherapy

This case report details a ceftriaxone-resistant Aeromonas hydrophila infection in a 32-year-old man following medicinal leech therapy for a gracilis muscle flap, with the infection developing despite intravenous ceftriaxone prophylaxis. For the American Society of Hirudotherapy, this finding is highly relevant as it documents the failure of a standard prophylactic antibiotic, highlighting the necessity of tracking evolving bacterial resistance in leech symbionts. The primary limitation is that this relies on a single case report, which cannot establish the overall prevalence of ceftriaxone resistance but serves as a vital clinical warning. Practitioners must remain vigilant that standard antibiotic prophylaxis may not universally prevent leech-associated infections.

Citation

Ceftriaxone-Resistant Aeromonas hydrophila Infection Following Leech Therapy: A New Resistant Strain.

Bykowski MR, Zhu X, Diaz-Garcia R · Annals of plastic surgery, 2018

DOI

Added to ASH library: May 26, 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.