CLINICAL NOTE Leech-Transmitted Ciprofloxacin-Resistant Aeromonas hydrophila Eric W. Wang, MD; David K. Warren, MD, MPH; Vicky M. Ferris, RN; Ed Casabar, PharmD; Brian Nussenbaum, MD he use of medicinal leeches (Hirudo medicinalis) is effective in establishing venous out- 1,2 flow in congested flaps and replants. Leech therapy also has associated risks, includ- ing significant blood loss requiring transfusions and infections from Aeromonas, a gram- T negative bacilli. Leeches maintain a symbiotic relationship with Aeromonas species, which are resident to their gut in order to digest blood. Aeromonas hydrophila infections can result in extensive soft-tissue infections and myonecrosis. To prevent this devastating nosocomial in- fection, ciprofloxacin and/or trimethoprim-sulfamethoxazole (TMP-SMX) are the most com- 1,4 monly used prophylactic antibiotics when patients undergo leech therapy. Fluoroquinolone resistance in Aeromo- dibulectomy resulted in an 11-cm antero- nas species has been rarely reported from lateral mandibular defect. The facial artery strains isolated from environmental and 2 branches from the facial vein were 5,6 sources. The overall incidence of fluo- used for the microvascular anastomoses. roquinolone or TMP-SMX resistance in Perioperatively, the patient was treated 4,7 Aeromonas species is very low. We re- with ampicillin-sulbactam. Approxi- port a case in which a sentinel nosoco- mately
JAMA Otolaryngology - Head & Neck Surgery – American Medical Association
Published: Feb 1, 2011
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