Infections following the application of leeches: two case reports and review of the literature
Maetz B, Abbou R, Andreoletti JB, Bruant-Rodier C (2012) · Journal of Medical Case Reports · n=2
RCT evidence detailTrial reference
Study Profile
- Design
- two-case report with literature review (Hôpitaux Universitaires de Strasbourg)
- Sample size (n)
- 2
- Intervention
- Leech therapy applied to congested transverse rectus abdominis myocutaneous (TRAM) flaps for delayed mammary reconstruction in two women (ages 55 and 56) with subsequent Aeromonas veronii biovar sobria septicemia
- Comparator
- Historical leech-treated TRAM cohort without sepsis (literature)
- Primary endpoint
- Sepsis occurrence, microbiologic identification, antibiotic responsiveness
- Primary result
- Both patients developed Aeromonas veronii biovar sobria septicemia (day 6 and day 7 postoperative); both responded to 4 days of antibiotic treatment; amoxicillin/clavulanic acid resistance documented; sensitivity to third-generation cephalosporins and fluoroquinolones
- Follow-up duration
- Hospitalization through fever resolution
- PMID
- 23098279
Key Findings
- A. veronii biovar sobria identified as leech-associated pathogen (not A. hydrophila)
- Septicemia at day 6-7 postoperative in both cases
- Amoxicillin/clavulanic acid resistance documented
- Sensitivity to third-generation cephalosporins and fluoroquinolones
- Supports oral fluoroquinolone prophylaxis throughout leech treatment
Limitations
- Only 2 cases - hypothesis-generating
- Cannot quantify infection incidence rate
- Aeromonas concentration reportedly decreases with antibiotic exposure
- Antibiotic sensitivity patterns evolving
- Single institution experience
Clinical Implications
Maetz 2012 expands the leech-associated infection profile beyond Aeromonas hydrophila to include A. veronii biovar sobria. For US clinicians under K040187, this case report reinforces the importance of fluoroquinolone prophylaxis throughout leech therapy duration and the need to consider broad-spectrum coverage for late-onset (day 6-7) sepsis. Updates antibiotic resistance profile relevant for protocol design.
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