TY - JOUR
T1 - Multidrug resistant Aeromonas infection following medical leech therapy
T2 - A case report and development of a joint antimicrobial stewardship and infection prevention protocol
AU - Masters, Mary Clare
AU - Gupta, Aakash R.
AU - Rhodes, Nathaniel J.
AU - Flaherty, John P.
AU - Zembower, Teresa R.
AU - Alghoul, Mohammed S
AU - Krueger, Karen M.
N1 - Publisher Copyright:
© 2020
PY - 2020/12
Y1 - 2020/12
N2 - Objective: Aeromonas sp. infections are a recognized complication of medical leech therapy (MLT). In patients requiring MLT, ciprofloxacin or trimethoprim–sulphamethoxazole are commonly used to prevent such nosocomial infections. After a patient at our institution developed a MLT-associated multi-drug resistant (MDR) Aeromonas infection, we developed and evaluated a joint antimicrobial stewardship and infection prevention protocol for MLT at our institution. Methods: We describe a case of a surgical site infection with MDR Aeromonas following MLT that was resistant to typically prescribed prophylactic antimicrobials, and development of a new leech culture protocol to proactively monitor for antimicrobial resistance among our institution's leech supply. We also report the rates of MLT-associated infections prior to and following implementation of this protocol and the antimicrobial susceptibility profiles detected in leech culture at our institution. Results: Between October 2014 and February 2018, 46 patients received MLT at our institution. Other than the case described in this report, no other instances of MLT-related infections were noted during this time period. Culture results from 22 leeches in six batches since February 2018 showed that all were susceptible to ciprofloxacin, TMP-SMX, and ceftriaxone. Since initiation of a leech culture protocol, no further cases of MLT-associated infections have been reported at our institution. Conclusions: In light of increasing antimicrobial resistance and the potentially devastating consequences of MLT-associated infections, institutions offering MLT should be aware of these risks and ensure that protocols are in place to minimize infection risks for patients.
AB - Objective: Aeromonas sp. infections are a recognized complication of medical leech therapy (MLT). In patients requiring MLT, ciprofloxacin or trimethoprim–sulphamethoxazole are commonly used to prevent such nosocomial infections. After a patient at our institution developed a MLT-associated multi-drug resistant (MDR) Aeromonas infection, we developed and evaluated a joint antimicrobial stewardship and infection prevention protocol for MLT at our institution. Methods: We describe a case of a surgical site infection with MDR Aeromonas following MLT that was resistant to typically prescribed prophylactic antimicrobials, and development of a new leech culture protocol to proactively monitor for antimicrobial resistance among our institution's leech supply. We also report the rates of MLT-associated infections prior to and following implementation of this protocol and the antimicrobial susceptibility profiles detected in leech culture at our institution. Results: Between October 2014 and February 2018, 46 patients received MLT at our institution. Other than the case described in this report, no other instances of MLT-related infections were noted during this time period. Culture results from 22 leeches in six batches since February 2018 showed that all were susceptible to ciprofloxacin, TMP-SMX, and ceftriaxone. Since initiation of a leech culture protocol, no further cases of MLT-associated infections have been reported at our institution. Conclusions: In light of increasing antimicrobial resistance and the potentially devastating consequences of MLT-associated infections, institutions offering MLT should be aware of these risks and ensure that protocols are in place to minimize infection risks for patients.
KW - Aeromonas
KW - Antimicrobial stewardship
KW - Infection prevention
KW - Medical leech therapy
KW - Multidrug resistance
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U2 - 10.1016/j.jgar.2020.10.010
DO - 10.1016/j.jgar.2020.10.010
M3 - Article
C2 - 33137533
AN - SCOPUS:85097425055
VL - 23
SP - 349
EP - 351
JO - Journal of Global Antimicrobial Resistance
JF - Journal of Global Antimicrobial Resistance
SN - 2213-7165
ER -