Verriere B, Sabatier B, Carbonnelle E, Mainardi J L, Prognon P, Whitaker I, Lantieri L, Hivelin M
Pharmacy Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France.
Microbiology Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France.
Eur J Clin Microbiol Infect Dis. 2016 Jun;35(6):1001-6. doi: 10.1007/s10096-016-2629-5. Epub 2016 Apr 2.
While the use of medicinal leech therapy (MLT) in reconstructive and orthopaedic surgery is widely described, post-operative complications related to leeches remain a major concern. Aeromonas spp. strains are involved in the majority of reported cases. As surgical success rate is directly impacted, an adapted antibiotic prophylaxis should be instituted in order to minimize these complications. We assessed pharmaceutical process, microbiological control and related infections in order to provide data and choose the appropriate antibiotherapy for patients requiring MLT. We report a clinical and microbiological study over a 24-month period. Clinical data were collected from patients' database, and microbiological analysis both on leeches' tank water and crushed leeches were performed to characterize isolated strains and their susceptibility to antibiotics. A total of 595 leeches were used to treat 28 patients (12 in plastic surgery and 16 in orthopaedic surgery), and three documented cases of post-operative infections were reported. Aeromonas spp. isolates yielded from 62 % of analyzed batches (75 % of Aeromonas veronii). Eighteen Aeromonas spp. isolates yielded from 23 water samples and three crushed leeches. Isolates were similar in tank and crushed leeches. Strains were susceptible to fluoroquinolones, sulfamethoxazole/trimethoprim, aminosides, and third-generation cephalosporins but resistant to amoxicillin/clavulanic acid and second-generation cephalosporins. According to collected data, routine tank water microbiological analyses are mandatory in order to identify leeches' batches containing resistant strains and to discard them. In this context, the surgeon is able to select an appropriated antibiotic prophylaxis in order to avoid MLT associated serious post-operative complications.
虽然药用蚂蟥疗法（MLT）在重建外科和整形外科中的应用已有广泛描述，但与蚂蟥相关的术后并发症仍是一个主要问题。大多数报告病例都涉及气单胞菌属菌株。由于手术成功率直接受到影响，应采取适当的抗生素预防措施以尽量减少这些并发症。我们评估了制药过程、微生物控制和相关感染情况，以便提供数据并为需要MLT的患者选择合适的抗微生物疗法。我们报告了一项为期24个月的临床和微生物学研究。临床数据从患者数据库中收集，并对蚂蟥养殖水箱中的水和碾碎的蚂蟥进行微生物分析，以鉴定分离出的菌株及其对抗生素的敏感性。总共使用了595只蚂蟥来治疗28例患者（12例整形外科患者和16例骨科手术患者），报告了3例有记录的术后感染病例。62%的分析批次分离出气单胞菌属菌株（75%为维罗纳气单胞菌）。从23份水样和3只碾碎的蚂蟥中分离出18株气单胞菌属菌株。水箱中的蚂蟥和碾碎的蚂蟥中的分离菌株相似。这些菌株对氟喹诺酮类、磺胺甲恶唑/甲氧苄啶、氨基糖苷类和第三代头孢菌素敏感，但对阿莫西林/克拉维酸和第二代头孢菌素耐药。根据收集到的数据，必须对水箱水进行常规微生物分析，以识别含有耐药菌株的蚂蟥批次并将其丢弃。在此背景下，外科医生能够选择合适的抗生素预防措施，以避免与MLT相关的严重术后并发症。
