Transmission of Aeromonas hydrophila by leeches

Abstract

On July 1, 2012, a 47-year-old man sustained a crush injury of the left hand and was admitted to the Hand Emergency Unit, Conception Hospital, Marseille Public Hospitals, Marseille, France, with a large palmar skin defect. Emergency reconstruction of the palmar wound was done with a radial forearm fl ap. From day 2 to day 6 after surgery, ten leeches were applied to the fl ap to treat venous congestion, and oral ciprofl oxacin prophylaxis (1 g per day) was given. On day 6, the patient developed a body temperature of 37·8°C. On examination, the fl ap was foul smelling. 3 days later, surgical debridement was done because of some fl ap necrosis and the presence of pus. A daily combination of oral clindamycin, metronidazole, and cotrimoxazole was started. Perioperative sampling enabled isolation of an Aeromonas hydrophila strain that was resistant to ciprofl oxacin (minimum inhibitory concen tration [MIC] 3·0 μg/mL by Epsilometer test [AB-Biodisk, Solna, Sweden]), a phenotype that had not been previously seen in our hospital. Subsequently, cotrimoxa zole alone was given for a further 16 days. The patient was last seen on Oct 23, 2013, when he was judged cured. On July 25, 2012, the same ciprofl oxacin-resistant A hydrophila strain was isolated from the necrotising righthand dorsal fl ap of a 35-year-old patient who had been treated with 11 leeches from the same batch, despite ciprofl oxacin prophylaxis. Of the seven patients treated with leeches from the same batch in July, 2012, surgical site A hydrophila infection was identifi ed in two. Cultures of 100 mL of water from the two leech aquariums grew ciprofl oxacin-resistant A hydrophila, but bottled mineral water used to fi ll these aquariums was sterile. Ciprofl oxacinresistant A hydrophila was also grown from a new batch of 50 leeches that were tested on arrival. Lancet 2013; 381: 1686