American Society of Hirudotherapy

Evolving Antibiotic Resistance of Aeromonas Species in Finger Replantation

Case series published in Surgical Infections (2019)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Research reportSafety & Infection ControlMokhtar K, Culnan DM, Lineaweaver WC · Surgical infections, 2019

Abstract

Background: Infections with Aeromonas spp. are a recognized complication of leech therapy for circulatory complications in replanted digits. Ciprofloxacin is commonly used empirically for Aeromonas coverage in such cases. Evolving resistance patterns of Aeromonas should be considered in designing an antibiotic strategy. Methods: Three consecutive patients with complicated replantations had site cultures yielding Aeromonas isolates resistant to ciprofloxacin. These cultures were analyzed to identify effective antibiotic agents. Results: Each Aeromonas isolate, and each additional site organism, was sensitive to cefepime. Conclusion: Our routine antibiotic coverage for leech application has been changed to cefepime. Aeromonas sensitivities and resistances should be monitored to adapt to future changes in appropriate antibiotics.

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

Publication typeJournal Article
Indexed MeSH termsAeromonasAnti-Bacterial AgentsCefepimeCiprofloxacinDrug Resistance, MicrobialHumansLeechingMicrobial Sensitivity TestsReplantation

Summary

Three consecutive replantations with leech application yielded ciprofloxacin-resistant Aeromonas isolates sensitive to cefepime, motivating change of routine antibiotic coverage for leech therapy to cefepime.

Why This Matters for Hirudotherapy

This report examined Aeromonas infection complicating leech therapy after digit replantation, describing three consecutive patients whose site cultures yielded ciprofloxacin-resistant Aeromonas isolates and testing those isolates for effective antibiotics. For ASH and hirudotherapy, it is directly relevant because Aeromonas infection is a recognized complication of medicinal leech use in replanted digits; emerging ciprofloxacin resistance challenges commonly used empirical coverage, and the finding that each isolate was sensitive to cefepime led the authors to change their routine leech-application antibiotic to cefepime. The key caveat is that this is a small case series, not a comparative trial or resistance-surveillance study, so it cannot define general prevalence or universal prophylaxis; local sensitivities should be monitored and treatment individualized.

Citation

Evolving Antibiotic Resistance of Aeromonas Species in Finger Replantation.

Mokhtar K, Culnan DM, Lineaweaver WC · Surgical infections, 2019

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.