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The role of leech water sampling in choice of prophylactic antibiotics in medical leech therapy
Author(s) -
Wilmer Amanda,
Slater Karen,
Yip Judy,
Carr Nicholas,
Grant Jennifer
Publication year - 2013
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.22087
Subject(s) - leech , aeromonas , medicine , antibiotics , hirudo medicinalis , ciprofloxacin , aeromonas hydrophila , microbiology and biotechnology , biology , fish <actinopterygii> , bacteria , fishery , genetics , world wide web , computer science
Medical leech therapy (MLT) with Hirudo medicinalis is well established as a treatment for venous congestion of tissue flaps, grafts, and replants. Unfortunately, this treatment is associated with surgical site infections with bacterial species, most commonly Aeromonas hydrophila , which is an obligate symbiot of H. medicinalis . For this reason, prophylactic antibiotics are recommended in the setting of MLT. After culturing Aeromonas hydrophila resistant to ciprofloxacin from a tissue specimen from a patient with a failed replant of three digits post‐MLT, we performed environmental surveillance cultures and antibiotic susceptibility testing on water collected from leech tanks. This surveillance was performed twice weekly for 2.5 months. Fourteen surveillance cultures demonstrated 21 isolates of Aeromonas species, 71.4% of which were ciprofloxacin susceptible. All isolates were sulfamethoxazole‐trimethoprim (SXT) susceptible. The prophylactic antibiotic regimen of choice for leech therapy at our institution is SXT, with culture of tank water to refine antimicrobial choice if necessary. This study demonstrates the importance of regular surveillance to detect resistant Aeromonas species in medical leeches; however optimal practice has not been established. © 2013 Wiley Periodicals, Inc. Microsurgery, 2013.