Multidrug resistant Aeromonas infection following medical leech therapy: A case report and development of a joint antimicrobial stewardship and infection prevention protocol
Case report with protocol published in J Glob Antimicrob Resist (2020)
Abstract
OBJECTIVE: Aeromonas sp. infections are a recognized complication of medical leech therapy (MLT). In patients requiring MLT, ciprofloxacin or trimethoprim-sulphamethoxazole are commonly used to prevent such nosocomial infections. After a patient at our institution developed a MLT-associated multi-drug resistant (MDR) Aeromonas infection, we developed and evaluated a joint antimicrobial stewardship and infection prevention protocol for MLT at our institution. METHODS: We describe a case of a surgical site infection with MDR Aeromonas following MLT that was resistant to typically prescribed prophylactic antimicrobials, and development of a new leech culture protocol to proactively monitor for antimicrobial resistance among our institution's leech supply. We also report the rates of MLT-associated infections prior to and following implementation of this protocol and the antimicrobial susceptibility profiles detected in leech culture at our institution. RESULTS: Between October 2014 and February 2018, 46 patients received MLT at our institution. Other than the case described in this report, no other instances of MLT-related infections were noted during this time period. Culture results from 22 leeches in six batches since February 2018 showed that all were susceptible to ciprofloxacin, TMP-SMX, and ceftriaxone. Since initiation of a leech culture protocol, no further cases of MLT-associated infections have been reported at our institution. CONCLUSIONS: In light of increasing antimicrobial resistance and the potentially devastating consequences of MLT-associated infections, institutions offering MLT should be aware of these risks and ensure that protocols are in place to minimize infection risks for patients.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Multi-drug resistant Aeromonas infection following medical leech therapy prompted development of a joint antimicrobial stewardship and infection prevention protocol combining culture-guided prophylaxis with strict aseptic handling.
Why This Matters for Hirudotherapy
This case report describes a surgical site infection with multidrug-resistant (MDR) Aeromonas following medical leech therapy (MLT) in a patient whose prophylactic antimicrobials would not have covered the resistant organism. Following this event, the institution developed a leech culture protocol to proactively monitor antimicrobial resistance among their leech supply; subsequent culturing of 22 leeches across six batches showed susceptibility to ciprofloxacin, TMP-SMX, and ceftriaxone, and no further MLT-associated infections occurred. Among 46 patients receiving MLT over the study period, only the index case developed infection. This study is directly relevant to ASH's domain as it addresses a recognized safety complication of hirudotherapy. The findings highlight the importance of antimicrobial stewardship and leech culture surveillance protocols to mitigate infection risk in clinical leech practice, particularly given emerging antimicrobial resistance in Aeromonas species.
Citation
Multidrug resistant Aeromonas infection following medical leech therapy: A case report and development of a joint antimicrobial stewardship and infection prevention protocol.
Masters MC et al. · Journal of global antimicrobial resistance, 2020
Added to ASH library: May 26, 2026 · Site last updated: June 18, 2026