American Society of Hirudotherapy

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

Case series published in Journal of Hand Surgery (2014)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Case reportSafety & Infection Controlvan Alphen NA, Gonzalez A, McKenna MC, McKenna TK, Carlsen BT, Moran SL · The Journal of hand surgery, 2014

Abstract

Medicinal leeches are commonly used after finger replantation to treat surgically unsalvageable venous congestion. Infection from Aeromonas hydrophila is a recognized complication of leech therapy that can be underestimated by the medical community. Ciprofloxacin and trimethoprim-sulfamethoxazole are the most commonly recommended prophylactic antibiotics used to prevent A. hydrophila infections during leech therapy. Here, we report 2 cases of ciprofloxacin-resistant Aeromonas infections, occurring within 4 months of each other. Both cases developed after leech therapy for unsuccessful digital replantation. These infections were successfully treated with ceftriaxone. Ciprofloxacin-resistant Aeromonas should be recognized when determining prophylactic antibiotic protocols for replant centers when leech therapy is used for finger replantation.

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

Publication typeCase ReportsJournal Article
Indexed MeSH termsAdultAeromonas hydrophilaAnimalsAnti-Bacterial AgentsCiprofloxacinDrug Resistance, BacterialFinger InjuriesGram-Negative Bacterial InfectionsHumansLeechingMiddle AgedReplantation

Summary

Two consecutive cases of ciprofloxacin-resistant Aeromonas infection in finger replantation patients receiving leech therapy, successfully treated with ceftriaxone, demand reconsideration of prophylactic regimens in replant centers.

Why This Matters for Hirudotherapy

This report describes two cases of ciprofloxacin-resistant Aeromonas infections occurring within four months of each other, both developing after leech therapy for unsuccessful digital replantation. The infections were successfully treated with ceftriaxone. The authors note that ciprofloxacin and trimethoprim-sulfamethoxazole are the most commonly recommended prophylactic antibiotics for preventing A. hydrophila infections during leech therapy, and suggest that ciprofloxacin-resistant Aeromonas should be recognized when determining prophylactic antibiotic protocols for replant centers using leech therapy. This is relevant to hirudotherapy practice, as it documents clinical infections caused by ciprofloxacin-resistant strains associated with medicinal leech use. However, the evidence is limited to two case reports, and no data on resistance prevalence, alternative prophylactic efficacy, or broader epidemiological patterns are provided.

Citation

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 · The Journal of hand surgery, 2014

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.