Implementing Infection Prevention for Leech Therapy

BACKGROUND Leech therapy is used as a post-operative treatment for plastic and reconstructive surgery. Aeromonas hydrophila, the bacteria present in the leech digestive system, has been associated with infection following therapy. In early 2018, a patient receiving leech therapy at our facility developed a highly resistant A. hydrophila bacteremia. This case prompted an evaluation of the infection prevention measures for leech therapy that were in place at our facility. METHODS Pharmacy, Microbiology and Infection Prevention departments evaluated usage of leeches. A process was developed to detect antimicrobial resistance by testing one leech from each lot of 50 upon delivery and then every 30 days. A retrospective chart review of 46 orders was performed from October 2014 to February 2018. To determine antimicrobial resistance, 22 samples from 6 leech lots were cultured and evaluated. RESULTS The majority of 46 orders (93.3%), ranging from 10 to 308 leeches per patient, were placed by plastic surgery physicians and ceftriaxone or trimethoprim/sulfamethoxazole were the most common prophylaxis agents given. Of the 22 leech samples, 100% were resistant to ampicillin and ampicillin/sulbactam; 77% to meropenem; 64% to piperacillin/tazobactam; and 18% to cefazolin. All were susceptible to ciprofloxacin, trimethoprim/sulfamethoxazole and ceftriaxone. A protocol was developed from the process and there have been no further cases of leech associated infections post therapy. CONCLUSIONS The collaborative reviewed current practices and developed an infection prevention protocol for leech therapy. This protocol detects resistance and guides antimicrobial prophylactic choices. If critical antimicrobial results are identified, the lot is quarantined from patient use until effective antibiotic therapy is determined. Unless emergent therapy is needed, antibiotic prophylaxis is culture directed based on the susceptibility profiles. Facilities offering leech therapy should evaluate their process and develop protocols to decrease infection risks to patients. Leech therapy is used as a post-operative treatment for plastic and reconstructive surgery. Aeromonas hydrophila, the bacteria present in the leech digestive system, has been associated with infection following therapy. In early 2018, a patient receiving leech therapy at our facility developed a highly resistant A. hydrophila bacteremia. This case prompted an evaluation of the infection prevention measures for leech therapy that were in place at our facility. Pharmacy, Microbiology and Infection Prevention departments evaluated usage of leeches. A process was developed to detect antimicrobial resistance by testing one leech from each lot of 50 upon delivery and then every 30 days. A retrospective chart review of 46 orders was performed from October 2014 to February 2018. To determine antimicrobial resistance, 22 samples from 6 leech lots were cultured and evaluated. The majority of 46 orders (93.3%), ranging from 10 to 308 leeches per patient, were placed by plastic surgery physicians and ceftriaxone or trimethoprim/sulfamethoxazole were the most common prophylaxis agents given. Of the 22 leech samples, 100% were resistant to ampicillin and ampicillin/sulbactam; 77% to meropenem; 64% to piperacillin/tazobactam; and 18% to cefazolin. All were susceptible to ciprofloxacin, trimethoprim/sulfamethoxazole and ceftriaxone. A protocol was developed from the process and there have been no further cases of leech associated infections post therapy. The collaborative reviewed current practices and developed an infection prevention protocol for leech therapy. This protocol detects resistance and guides antimicrobial prophylactic choices. If critical antimicrobial results are identified, the lot is quarantined from patient use until effective antibiotic therapy is determined. Unless emergent therapy is needed, antibiotic prophylaxis is culture directed based on the susceptibility profiles. Facilities offering leech therapy should evaluate their process and develop protocols to decrease infection risks to patients.