Brauer Philip R, Saadah Malaak, Fritz Michael A, Wu Shannon S, Lamarre Eric D
Head and Neck Institute, The Cleveland Clinic, Cleveland, OH, USA.
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Am J Otolaryngol. 2024 Nov-Dec;45(6):104500. doi: 10.1016/j.amjoto.2024.104500. Epub 2024 Aug 14.
Given rising concern regarding antibiotic resistance, our objective was to evaluate antibiotic-resistant infections following leech therapy and to characterize the use of prophylactic antibiotics.
All reports of adverse events involving hirudotherapy (product code "NRN") were retrieved from the U.S. Food and Drug Administration MAUDE database between 2012 and 2021. Antibiotic resistance was defined by bacterial culture or infection after antibiotic administration.
Nineteen cases of antibiotic resistance involving hirudotherapy were identified. Only three cases of antibiotic resistance were discovered on routine testing and the remaining 16 cases were associated with patient injury. Positive blood cultures or fever were present in 26.3 % (n = 5) of cases. Cultures of the infection grew Aeromonas hydrophilia (n = 13; 68.4 %), Vibrio vulnificus (n = 3; 15.8 %), Pseudomonas aeruginosa (n = 2; 10.5 %), and Proteus vulgaris (n = 1; 5.3 %). There were nine (47.4 %) multi-drug resistant infections. Infection was most commonly resistant to fluoroquinolones (n = 9; 47.4 %), trimethoprim-sulfamethoxazole (n = 9; 47.4 %) and ertapenem (n = 4; 21.1 %).
Antibiotic-resistant infections involving hirudotherapy are frequently resistant to multiple drugs, including fluoroquinolones and trimethoprim-sulfamethoxazole. Resistance to ertapenem, a drug of last resort, was also documented. The findings presented in this study support growing literature that the trend in multi-drug resistance is more severe than previously reported.
鉴于对抗生素耐药性的关注度不断提高，我们的目的是评估水蛭疗法后的抗生素耐药性感染情况，并描述预防性抗生素的使用特征。
检索了2012年至2021年间美国食品药品监督管理局MAUDE数据库中所有涉及水蛭疗法（产品代码“NRN”）的不良事件报告。抗生素耐药性通过抗生素给药后的细菌培养或感染来定义。
确定了19例涉及水蛭疗法的抗生素耐药性病例。仅3例抗生素耐药性是在常规检测中发现的，其余16例与患者损伤有关。26.3%（n = 5）的病例出现血培养阳性或发热。感染培养物中生长出嗜水气单胞菌（n = 13；68.4%）、创伤弧菌（n = 3；15.8%）、铜绿假单胞菌（n = 2；10.5%）和普通变形杆菌（n = 1；5.3%）。有9例（47.4%）为多重耐药感染。感染最常见的是对氟喹诺酮类耐药（n = 9；47.4%）、对甲氧苄啶-磺胺甲恶唑耐药（n = 9；47.4%）和对厄他培南耐药（n = 4；21.1%）。
涉及水蛭疗法的抗生素耐药性感染通常对多种药物耐药，包括氟喹诺酮类和甲氧苄啶-磺胺甲恶唑。对作为最后手段的药物厄他培南的耐药性也有记录。本研究中的发现支持了越来越多的文献观点，即多重耐药趋势比之前报道的更为严重。
