P32 – Evaluation of antimicrobial prophylaxis among patients receiving medicinal leech therapy

Author(s):
Brian Gilbert, Rachel Kruer, University of Florida, Jacksonville

Background: Medicinal leeches (Hirudo medicinalis) are an important therapy in plastic and reconstructive surgery. Leeches are indicated for salvage of tissue flaps, grafts, or replants. The use of medicinal leeches does not come without risk; infection threatens graft survival. Antimicrobial prophylaxis is recommended.

Hypothesis: Prophylactic antimicrobial administration will prevent leech-associated Aeromonas spp. infections.

Methods: Patients 18 years or older were included if they received leech therapy and were admitted to the hospital between December 2009 – February 2013. A query of patients with orders for medicinal leeches was performed via the pharmacy electronic medication order management system. The primary outcome of this study was to describe the incidence of wound site infection or bacteremia associated with leech therapy in patients receiving prophylaxis and the associated pathogens isolated from cultures within 48 hours of receiving leech therapy. Secondary objectives were to describe antimicrobials utilized for prophylaxis, and evaluate adverse effects associated with antimicrobials.

Results: Thirty-two patients received leech therapy and 31 met inclusion criteria. The mean age of patients included was 58 (+/- 13). Fifty-five percent of patients were male. The mean number of days of leech therapy was 5.2 (+/- 2.9). Thirty patients received antibiotic prophylaxis; 17 received trimethoprim/sulfamethoxazole, 12 received ciprofloxacin, and one received ceftriaxone. Of the patients who received antimicrobial prophylaxis, four patients had positive cultures. One patient had a Proteus vulgaris surgical site infection, resistant to the prophylactic agent utilized. One patient had a Candida parapsilosis surgical wound site infection. Two patients had urine cultures positive for Enterococcus; one patient was treated for an infection and one was not. Trimethoprim/sulfamethoxazole was discontinued in one patient due to rash.

Conclusions: Given antimicrobial prophylaxis with trimethoprim/sulfamethoxazole, ciprofloxacin, or ceftriaxone, no patients in this study developed an infection with Aeromonas spp. One patient developed a surgical site infection with Proteus vulgaris, resistant to the prophylactic agent used. The antimicrobial agents utilized in this study were associated with minimal adverse effects.