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Prophylactic use of levofloxacin during medicinal leech therapy

Tieneke Bauters (UGent) , Franky Buyle (UGent) , Stijn Blot (UGent) , Hugo Robays (UGent) , Dirk Vogelaers (UGent) , Koenraad Van Landuyt (UGent) , Wim Vanhove and Geert Claeys (UGent)
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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
Antibiotic prophylaxis, Aeromonas species, Hirudo medicinalis, Leech therapy, Levofloxacin, SURGICAL SITE INFECTIONS, AEROMONAS-HYDROPHILA, HIRUDO-MEDICINALIS, RETURN, COSTS

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Chicago
Bauters, Tieneke, Franky Buyle, Stijn Blot, Hugo Robays, Dirk Vogelaers, Koenraad Van Landuyt, Wim Vanhove, and Geert Claeys. 2014. “Prophylactic Use of Levofloxacin During Medicinal Leech Therapy.” International Journal of Clinical Pharmacy 36 (5): 995–999.
APA
Bauters, Tieneke, Buyle, F., Blot, S., Robays, H., Vogelaers, D., Van Landuyt, K., Vanhove, W., et al. (2014). Prophylactic use of levofloxacin during medicinal leech therapy. INTERNATIONAL JOURNAL OF CLINICAL PHARMACY, 36(5), 995–999.
Vancouver
1.
Bauters T, Buyle F, Blot S, Robays H, Vogelaers D, Van Landuyt K, et al. Prophylactic use of levofloxacin during medicinal leech therapy. INTERNATIONAL JOURNAL OF CLINICAL PHARMACY. 2014;36(5):995–9.
MLA
Bauters, Tieneke, Franky Buyle, Stijn Blot, et al. “Prophylactic Use of Levofloxacin During Medicinal Leech Therapy.” INTERNATIONAL JOURNAL OF CLINICAL PHARMACY 36.5 (2014): 995–999. Print.
@article{5683698,
  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.},
  author       = {Bauters, Tieneke and Buyle, Franky and Blot, Stijn and Robays, Hugo and Vogelaers, Dirk and Van Landuyt, Koenraad and Vanhove, Wim and Claeys, Geert},
  issn         = {2210-7703},
  journal      = {INTERNATIONAL JOURNAL OF CLINICAL PHARMACY},
  keyword      = {Antibiotic prophylaxis,Aeromonas species,Hirudo medicinalis,Leech therapy,Levofloxacin,SURGICAL SITE INFECTIONS,AEROMONAS-HYDROPHILA,HIRUDO-MEDICINALIS,RETURN,COSTS},
  language     = {eng},
  number       = {5},
  pages        = {995--999},
  title        = {Prophylactic use of levofloxacin during medicinal leech therapy},
  url          = {http://dx.doi.org/10.1007/s11096-014-9986-x},
  volume       = {36},
  year         = {2014},
}

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