Increasing multidrug resistance in leech borne infections. Should we adjust antibiotic treatment regime in plastic surgery? A systematic review

Background 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. led to the standard use of single antibiotics. 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. Methods We screened PubMed, Scopus, and Web of Science databases using relevant keywords including the last five decades addressing this issue. The review process was based on the PRISMA guidelines. 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. Result 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. Conclusions 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. Level of Evidence: Not ratable