Infections Associated with Treatment with Hirudo medicinalis - Report of Two Cases and Review of the Literature
Reese K, Gümbel D, Seifert J, Daeschlein G, Napp M, Ekkernkamp A (2015) · Handchirurgie, Mikrochirurgie, plastische Chirurgie · n=2
Study Profile
- Design
- case report series of two leech-therapy-associated wound infections plus systematic narrative literature review (Universitätsmedizin Greifswald, Germany)
- Sample size (n)
- 2
- Intervention
- Description of two German clinical cases in which Hirudo medicinalis leech therapy was used for different indications (microsurgical flap salvage and OA pain) and wound infection occurred
- Comparator
- No comparator - case-report-plus-review safety summary
- Primary endpoint
- Identification of leech-associated bacterial pathogens, infection management, and review of preventive measures
- Primary result
- Both cases showed wound infection in close temporal/spatial correlation with leech application or evidence of leech-associated germs; successful treatment with antibiotics in both cases; authors advocate strict indications and preventive antibiotic measures
- Follow-up duration
- until infection resolution
- PMID
- 26084860
Key Findings
- Documents two German cases of leech-therapy-associated wound infection in different clinical contexts
- Infections occurred with evidence of leech-associated germs (Aeromonas-spectrum)
- Both cases successfully treated with antibiotic therapy
- Authors advocate strict patient-selection criteria and preventive antibiotic measures
- Important counterweight to optimistic infection-rate reports in highly-controlled academic centers
Limitations
- Case-report study (n=2) - hypothesis-generating safety signal only
- Selection bias - case reports tend to over-represent adverse outcomes
- German single-center experience may not generalize globally
- No quantitative pooled analysis of infection rates across centers
- No GRADE rating in original publication
Clinical Implications
Reese 2015 provides a useful real-world reminder that leech therapy infections occur even in academic German centers and require active surveillance and management. For US clinicians, this case-report-plus-review supports the standard ASH-recommended prophylactic ciprofloxacin protocol and reinforces the importance of strict patient selection (avoiding immunocompromised hosts where feasible). The two reported cases were both successfully treated, illustrating that early recognition and prompt antibiotics enable favorable outcomes. The trial is included in this registry to balance the optimistic German RCT body with a published safety counterpoint.
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