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Evolving Antibiotic Resistance of Aeromonas Species in Finger Replantation
Khalid Mokhtar1, Derek M Culnan2, William C Lineaweaver2
1Pharmacy Department, Merit Health Central Hospital, Jackson, Mississippi.
Abstract:
Infections with Aeromonas spp. are a recognized complication of leech therapy for circulatory complications in replanted digits. Ciprofloxacin is commonly used empirically for Aeromonas coverage in such cases. Evolving resistance patterns of Aeromonas should be considered in designing an antibiotic strategy. Three consecutive patients with complicated replantations had site cultures yielding Aeromonas isolates resistant to ciprofloxacin. These cultures were analyzed to identify effective antibiotic agents. Each Aeromonas isolate, and each additional site organism, was sensitive to cefepime. Our routine antibiotic coverage for leech application has been changed to cefepime. Aeromonas sensitivities and resistances should be monitored to adapt to future changes in appropriate antibiotics.
Insights
Aeromonas infections can complicate leech therapy after digit replantation. Cefepime demonstrated effectiveness against ciprofloxacin-resistant Aeromonas isolates, leading to a change in antibiotic strategy.
Area of Science:
- Microbiology
- Infectious Diseases
- Surgical Complications
Background:
- Infections with Aeromonas species are a known complication of leech therapy used for circulatory issues in replanted digits.
- Ciprofloxacin is frequently prescribed empirically for Aeromonas coverage in these scenarios.
- Emerging resistance patterns in Aeromonas necessitate re-evaluation of antibiotic strategies.
Purpose of the Study:
- To investigate effective antibiotic agents against ciprofloxacin-resistant Aeromonas isolates found in complicated digit replantations.
- To inform empirical antibiotic selection for Aeromonas coverage in patients undergoing leech therapy.
Main Methods:
- Analysis of site cultures from three patients with complicated replantations yielding Aeromonas isolates.
- Antimicrobial susceptibility testing of Aeromonas isolates and other site organisms.
Main Results:
- All Aeromonas isolates, along with other encountered organisms, were sensitive to cefepime.
- Three consecutive patients presented with Aeromonas isolates resistant to ciprofloxacin.
Conclusions:
- Cefepime is an effective alternative for Aeromonas coverage in leech therapy, particularly when ciprofloxacin resistance is a concern.
- Continuous monitoring of Aeromonas antibiotic sensitivities and resistances is crucial for adapting treatment protocols.
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