Characterization of the Digestive Tract Microbiota of Hirudo orientalis ( Medicinal Leech ) and Antibiotic Resistance Profile SPECIAL TOPIC

408e Although blood letting and the use of leeches dates back to pharaonic Egypt,1 the U.S. Food and Drug Administration only approved the use of Hirudo medicinalis as a medical device in 2004.2 Leeches are used by plastic,3–7 maxillofacial,8–10 and other surgeons11,12 to aid salvage of venously congested pedicled flaps,13,14 freetissue transfers,3,15–17 replanted digits,6,18–25 ears,26–32 lips,33–36 nasal tips, and the penis.12 Nonsurgical uses include the treatment of chronic pain syndromes associated with degenerative diseases.37–39 From 1987, H. medicinalis was considered the sole European medicinal leech species in clinical use. In fact, there are at least three species: H. medicinalis, H. orientalis, and H. verbana.40,41 Although most commercial suppliers sell medicinal leeches labeled as H. medicinalis, Siddall et al.40 revealed that nearly all annelids were genetically distinct H. verbana. We have received shipments from commercial suppliers that contained both H. verbana and H. orientalis. It is likely that both are used in large quantities in North America and Northern Europe. Commercially used H. verbana mainly originate from Turkey, southeastern