J Orsini, G Sakoulas
aeromonas, leech therapy, wound infection
J Orsini, G Sakoulas. Surgical Site Infection Complicating Leech Therapy. The Internet Journal of Plastic Surgery. 2006 Volume 3 Number 1.
Aeromonas hydrophila infections are a recognized complication of postoperative leech application, and can occur with measurable frequency in populations of patients treated with leeches. We report a case of an abdominal flap infection caused by multiple organisms, including A. hydrophila, in a patient treated with leech therapy. Prompt surgical evaluation of wounds in combination with appropriate antibiotic therapy is recommended for the management of these infections.
A 57-year-old man was admitted for an elective abdominal wall reconstruction of a large ventral incisional hernia, which complicated emergent surgical repair of an abdominal aortic aneurysm rupture 2 years prior admission. One day after admission, he underwent a free tensor fascia lata (TFL) flap reconstruction. On hospital day 4th, he underwent exploratory laparotomy due to abdominal distention and superficial necrosis of the flap, with exploration and debridement of the TFL flap secondary to venous congestion. Leech therapy was initiated to alleviate the venous congestion of the TFL flap.
The postoperative course was complicated by persistent fevers (103°F), leukocytosis, worsening renal function, and purulent discharge from the surgical site. Intravenous vancomycin (1 g Q24h) and piperacillin/tazobactam (4.5 g Q8h) were initiated empirically. Relevant laboratory data included a white blood cell count of 12,4000/mm3, a hemoglobin of 13.8 g/dl, a platelet count 190,000/mm3, a serum creatinine 2.4 mg/dl, a creatine kinase 1118 units/L, and a C-reactive protein of 13.0 mg/dl. Liver function and coagulation studies were within normal limits. Chest radiography was normal.
His clinical condition improved after several days, with resolution of fever and renal function. Abdominal wound culture grew
The patient was discharged on intravenous antibiotic regimen composed of meropenem (1 g Q8h) and ciprofloxacin (400 mg Q12h) for 3 weeks, followed by ciprofloxacin (750 mg PO Q12h) for an additional 4 weeks. After several weeks, the patient was electively admitted for a removal of the infected mesh with a placement of an alloderm graft.
Gastroenteritis is the most common clinical manifestation of
Soft tissue infections from
Medicinal leeches have an important and expanding role in medicine, but infection can complicate their use. Leeches have been used by surgeons, especially those in plastics and reconstruction, to decrease venous congestion of skin flaps and to improve micro-revascularization of flaps, grafts and replants. Hirudin, a powerful anticoagulant that inhibits thrombin, is secreted in salivary secretions of leeches and injected into the flap. Hemoglobin that is sucked by the leeches is denaturated by
As this case illustrates, patients receiving medicinal leech therapy are at risk of developing
Antimicrobial therapy of
George Sakoulas, MD Division of Infectious Diseases New York Medical College Munger 245 Valhalla, NY 10595 Phone: 914-493-8865 Fax: 914-594-4973 Email: firstname.lastname@example.org