Ciprofloxacin-resistant Aeromonas infection following leech therapy for digit replantation: report of 2 cases

J Hand Surg Am. 2014 Mar;39(3):499-502. doi: 10.1016/j.jhsa.2013.11.041. Epub 2014 Feb 1.

Abstract

Medicinal leeches are commonly used after finger replantation to treat surgically unsalvageable venous congestion. Infection from Aeromonas hydrophila is a recognized complication of leech therapy that can be underestimated by the medical community. Ciprofloxacin and trimethoprim-sulfamethoxazole are the most commonly recommended prophylactic antibiotics used to prevent A. hydrophila infections during leech therapy. Here, we report 2 cases of ciprofloxacin-resistant Aeromonas infections, occurring within 4 months of each other. Both cases developed after leech therapy for unsuccessful digital replantation. These infections were successfully treated with ceftriaxone. Ciprofloxacin-resistant Aeromonas should be recognized when determining prophylactic antibiotic protocols for replant centers when leech therapy is used for finger replantation.

Keywords: Aeromonas; Replantation; antibiotic prophylaxis; antibiotic resistance; leeches.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aeromonas hydrophila
  • Animals
  • Anti-Bacterial Agents / therapeutic use*
  • Ciprofloxacin / therapeutic use*
  • Drug Resistance, Bacterial*
  • Finger Injuries / surgery*
  • Gram-Negative Bacterial Infections / drug therapy*
  • Gram-Negative Bacterial Infections / microbiology
  • Humans
  • Leeching / adverse effects*
  • Middle Aged
  • Replantation / methods*

Substances

  • Anti-Bacterial Agents
  • Ciprofloxacin