You have full access to this open access article. A growing number of reports of serious wound infections during medical leech therapy over the last decades caused by the leech gut symbiont Aeromonas spp. With more published data about raising multidrug resistance of Aeromonas species in leech guts, there is probably a need for adjustment of existing treatment regimens. We screened PubMed, Scopus, and Web of Science databases using relevant keywords including the last five decades addressing this issue.
Two independent reviewers screened the abstracts; extracted data were pooled and analyzed for antimicrobial resistance. Meta-analysis was not conducted, based on the poor quality of the included studies. A total of 43 studies were included in this review.
All of the studies were reports or case series—except one—and the quality was combined overall good. Evidence was not found for using special antimicrobial agents as first line therapy. Concluding this work, the survey revealed a growing number of more resistant or partially multi-resistant bacterial strains against different commonly used antibiotics, most probably based on increasing resistance in the environment.
Taking these data into account, we advise combining leech therapy with minimal dual antibiotic drug administration with ciprofloxacin and co-trimoxazol in the first place and leech gut sampling before inset for antibiotic drug resistance monitoring, and increased awareness during and after leech therapy. The use of leeches to treat soft tissue with congestion in plastic surgery gained over the last decades a sort of renaissance even with the parallel further development of micro- and supermicro surgery.
Main indications for this since FDA-approved medical device are often ring avulsion injuries, amputation of smaller parts, other mangled tissue with venous vessels too small to suture, or even soft tissue flaps with congestion. Leech therapy is further well known as a salvage option for tissue otherwise regarded impossible to save [ 1 ]. Despite the different potential complications with leech therapy like loss of blood and scaring, the main risk is still infection with a fatal outcome for congested tissue.
