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International Journal of Clinical Pharmacy

, Volume 36, Issue 5, pp 995–999 | Cite as

Prophylactic use of levofloxacin during medicinal leech therapy

  • Tiene Bauters
  • Franky Buyle
  • Stijn Blot
  • Hugo Robays
  • Dirk Vogelaers
  • Koen Van Landuyt
  • Wim Vanhove
  • Geert Claeys
Research Article

Abstract

Background Medicinal leech therapy is effective in establishing venous outflow in congested flaps and replants. However, its use is also associated with infections, especially from Aeromonas species. To prevent this nosocomial infection, levofloxacin has been established as prophylaxis during leech therapy in our hospital. Objectives To study the implementation rate of a guideline, to study the effect of levofloxacin on possible Aeromonas infections, and to evaluate the financial impact of this preventive measure. Setting A retrospective analysis on all patients treated with Hirudo medicinalis between July 2007 and March 2011 was performed at the Ghent University Hospital, Belgium. Method A list of patients treated with leeches was retrieved from the pharmacy database. Patient characteristics, date of start and stop of leech therapy were collected. Data on routine diagnostic cultures during leech therapy, date and type of clinical sample, while cultivated micro-organism with antibiotic susceptibility were obtained from the laboratory database. Main outcome measure percentage implementation rate of a guideline, presence of Aeromonas infections, financial impact of levofloxacin prophylaxis. Results Fifty-one patients were treated with leeches. Forty-six (90.2 %) patients were treated according the guideline. Fourteen out of 51 patients (27.5 %) were suspected for postoperative wound infections. From them, 60 clinical samples were sent for microbiological analysis. These included exudates (26.7 %), peroperative samples (5.0 %), puncture fluid (1.7 %), blood cultures (3.3 %) or smears from burns (63.3 %). No Aeromonas species were cultivated. Comparison between period before and after implementation of levofloxacin prophylaxis revealed that levofloxacin prevents colonization or infection with Aeromonas species in relation to leech therapy. The direct cost for levofloxacin prophylaxis in the current study was 2,570 euro. Based on data obtained in a previous study, we presume that a minimum cost-saving of 20,500 euro was realised during the current study period by implementation of antimicrobial prophylaxis. Conclusions This study demonstrates successful implementation of a guideline for levofloxacin prophylaxis during leech therapy. Following its introduction, no Aeromonas species related to the use of leeches were isolated as compared to 8.5 % in the baseline period.

Keywords

Aeromonas species Antibiotic prophylaxis Hirudo medicinalis Leech therapy Levofloxacin 

Notes

Acknowledgments

We thank Jolien Maertens for excellent assistance in collecting the data and Frits Desmet for cultivating the leeches.

Funding

None.

Conflicts of interest

The authors have no conflicts of interests.

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Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014

Authors and Affiliations

  • Tiene Bauters
    • 1
  • Franky Buyle
    • 1
  • Stijn Blot
    • 2
  • Hugo Robays
    • 1
  • Dirk Vogelaers
    • 3
  • Koen Van Landuyt
    • 4
  • Wim Vanhove
    • 5
  • Geert Claeys
    • 6
  1. 1.Department of PharmacyGhent University HospitalGhentBelgium
  2. 2.Department of Internal Medicine, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
  3. 3.Department of General Internal MedicineGhent University HospitalGhentBelgium
  4. 4.Department of Plastic SurgeryGhent University HospitalGhentBelgium
  5. 5.Department of Physical Medicine and OrthopedicsGhent University HospitalGhentBelgium
  6. 6.Department of Bacteriology of the Central LaboratoryGhent University HospitalGhentBelgium

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