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When administering antimicrobial prophylaxis in patients receiving medicinal leech therapy, clinicians should be familiar with the susceptibilities of Aeromonas species but also conscious of evolving antimicrobial resistance given the extent of the consequences of infected surgical grafts. Our case report highlights resistance changes in Aeromonas isolates associated with medicinal leeches and the potential for complications if isolates resistant to chosen prophylactic agents arise. When administering antimicrobial prophylaxis in patient