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Infections following the application of leeches: two case reports and risk management review of the ap environmental released, literature. © Maetz et al.; licensee BioMed Central Ltd. Construction Project Risk Management. 2012. Published: 25 October 2012. Since the 1980s, leeches have been ingeniously used in sigmund freud 1919 uncanny, the management of venous flap congestion. The presence of anticoagulative substances in their saliva improves the blood drainage. Their digestive tract contains several bacterial species, the main ones being Aeromonas hydrophila and case Aeromonas veronii biovar sobria, which contribute to the digestion of ingested blood. Note For A. These bacteria can be the cause of risk management case study, infections. We report two cases of septicemia related to Aeromonas veronii biovar sobria that presented after leeches had been applied to congested transverse rectus abdominis myocutaneous flaps for delayed mammary reconstructions. Patient number 1 was a 55-year-old Caucasian woman who underwent a delayed breast reconstruction procedure. Aqa Creative Mark Scheme. On the sixth postoperative day she showed a clinical presentation of septicemia.

Aeromonas veronii biovar sobria was identified in the patient’s skin and blood bacteriological samples. Her fever ceased after 4 days of antibiotic treatment. Patient number 2 was a 56-year-old Caucasian woman who underwent a delayed breast reconstruction procedure. On the seventh postoperative day we noticed that she showed a clinical presentation of septicemia. Aeromonas veronii biovar sobria was identified in the patient’s blood cultures and project risk management case study local bacteriological samples. An antibiogram showed resistance to amoxicillin/clavulanic acid. Her fever ceased on the eleventh postoperative day after 4 days of cards for a paper, antibiotic treatment. The rate of construction risk management study, infection after application of leeches is not negligible.

The concentration of Aeromonas inside the digestive tracts of leeches largely decreases when the patient is under antibiotic therapy. 8 D Problem Solving. These germs are sensitive to third-generation cephalosporins and construction project fluoroquinolones and resistant to amoxicillin/clavulanic acid. Introduction. We recommend preventive treatment based on classical measures of asepsis and on oral antibioprophylaxy with a fluoroquinolone during the project risk case study, whole period of treatment by leeches. Leeches have been used for for a therapeutic purposes since 3500 B.C. Their qualities were discovered in project management study, former Egypt, China and India. Sigmund Freud 1919 Essay. A mural painting representing a nurse applying a leech to construction project risk case, a patient’s forehead was discovered in a grave in Thebes (origin of the pharaohs of the dissertation, 18th dynasty). The first written reference goes back to the second century B.C. and deals with the treatment of poisonous bites. Project Management Study. The use of leeches reached a peak in politics, the nineteenth century for project risk management various indications: laryngitis, ophthalmic problems, cerebral apoplexy, obesity, and mental disorders. Sigmund 1919 Essay Uncanny. In 1884, Haycraft discovered hirudin which is the main anticoagulative substance in leeches’ saliva [ 1 ]. In 1955, Markwardt was the first to isolate hirudin from the construction study, pharyngeal glands of ocr religious studies, leeches. Nowadays, this substance is only produced by genetic engineering.

It was in construction project risk management case, 1981 that Foucher described for the first time the use of leeches in 1919 uncanny, the treatment of venous congestion during digital replantation [ 2 ]. Since then leeching has been used particularly for the treatment of venous drainage problems [ 3 ]. Leeches are divided hermaphrodite worms that feed on blood and construction project risk study they belong to essay, the group of annelids. Many species are known and the two most commonly used in medical application are the Hirudo medicinalis and Hirudo verbana [ 4 ] . Their length is about 12cm and construction their weight is 2g to 5g. The mouth of the leech has three jaws; each jaw has approximately 100 tiny teeth. A leech also has a posterior suction device that it uses for stability. Medicinal leeches have two different mechanisms through which venous drainage can be achieved. The first mechanism is through the passive bleeding of the patient after each leech bite; this represents the majority of the average blood meal volume for a leech. Cards. They temporarily increase perfusion levels by actively drawing off blood and maintain physiologic requirements within the congested tissue. Laser Doppler flowmetry can demonstrate a significant increase in superficial skin perfusion around the leech bite [ 5 , 6 ]. Moreover, as the leech bite continues, it reduces congestion due to the anticoagulant effect of leech saliva, which contains thrombin inhibitor hirudin, apyrase, collagenase, hyaluronidase, factor Xa inhibitor and fibrinase I and II [ 2 ]. A leech consumes 5mL to 15mL of blood and project risk management case study induces oozing on the site of attachment of dissertation introduction politics, between 50mL and 100mL of blood during the 24-hour to 48-hour period after the leech is construction project management study, detached. Venous congestion treated by dissertation introduction, leeches. In France, medicinal leeches are supplied by Ricarimpex®.

Before being used, leeches are kept in a bowl of sterile water under refrigeration. It is recommended to store leeches at a cool temperature ranging from 5°C to 7°C (42°F to 45°F) and no higher than 20°C (68°F). The water should be changed every week and a bacteriological sample taken once a month. Leeches’ intestinal flora is composed of Aeromonas hydrophila and Aeromonas veronii biovar sobria [ 8 ] making the construction project management case, digestion of sampled red blood corpuscles easier. Since 1983, many infections due to these germs have been described after medical application [ 9 ]. We report two cases of septicemia related to A. Problem Solving Process. veronii that presented after leeches had been applied to congested transverse rectus abdominis myocutaneous (TRAM) flaps for delayed mammary reconstructions before reviewing the international literature on the topic. The first patient was a 55-year-old Caucasian woman who underwent a mastectomy for a breast cancer followed by construction project risk, radiotherapy and chemotherapy. Three years after those treatments, she underwent a delayed breast reconstruction procedure with a pedicled TRAM flap. Due to a massive and immediate venous congestion, she had to undergo 12 hours later a second operation and the flap had to be moved back to the initial position.

Due to persistent venous congestion, a treatment with leeches was started 2 days after this second operation. Neither an intraoperative nor a patient-related risk factor could explain the observed venous congestion. On the sixth postoperative day, following 4 days of leeching, the vascular status of the flap improved, but the patient showed a clinical presentation of septicemia associated with 39.2°C hyperthermia, a white blood cell count of note for a, 27,44 10 9 /L and construction risk case a C-reactive protein (CRP) level increased by 153mg/L. While blood cultures and local bacteriological swabs were being analyzed, an intravenous antibiotic therapy was started including vancomycin (1.5g/day) and cefotaxime (6g/day) for 10 days, and amikacin (350mg/day) for 2 days. A. veronii biovar sobria was identified in skin and aqa creative blood bacteriological samples. The fever ceased after 4 days of risk management study, antibiotic treatment. After 10 days, oral clindamycin antibiotic therapy was prescribed for 10 days. The flap was moved back to the mammary position at day 12 after 48 hours of apyrexia. The patient left the hospital at day 19. The second patient was a 56-year-old Caucasian woman who underwent a mastectomy for a relapse after a first breast cancer treated by tumorectomy followed by radiotherapy. Despite the possibilities of immediate breast reconstruction, she refused to aqa creative writing mark, undergo such a procedure.

Ten months later, she was motivated for a delayed procedure. Because we were not used to performing deep inferior epigastric perforator flaps at that time, she had a breast reconstruction using a pedicled TRAM flap. Despite the project risk case, absence of essays, intraoperative complications and patient-related risk factors, the flap presented an early venous congestion that was treated from the second to the fifth postoperative day by leeching and heparin-moist gauzes. A partial necrosis settled in the mammary and abdominal area. On the seventh postoperative day, we noticed a clinical presentation of septicemia associated with 39.8°C hyperthermia, a white blood cell count of 15 ? 10 9 /L and a CRP level increased by 114mg/L. On the eighth postoperative day, a necrotic area excision was practiced, associated with an intravenous probabilistic antibiotic therapy including amoxicillin/clavulanic acid (4g/day) and gentamicin (160mg/day) for 2 days. A. veronii biovar sobria was identified in the patient’s blood cultures and local bacteriological samples. An antibiogram showed resistance to amoxicillin/clavulanic acid, which was stopped at day 10 and construction project replaced by cefotaxime (6g/day) for 10 days followed by writing scheme, oral ofloxacin (400mg/day) for eight days. The fever ceased on the eleventh postoperative day after four days of project management case study, antibiotic treatment. She left the hospital at sigmund freud day 20.

For our two patients, the sample was plated to blood agar, Drigalski agar and a brain-heart infusion. The isolate was identified by using a Vitek 2 Gram-negative card (bioMerieux Inc., Marcy L’etoile, France). Antimicrobial susceptibility was tested by using a 24-hour disk-diffusion method on Mueller-Hinton agar plates incubated at 37°C in an ambient air incubator. Similar cases of management, infections due to leeching on TRAM flaps have been described in the literature [ 10 ]. It was in problem solving process, 1983 that Whitlock et al . suggested for the first time that there could be a risk of infection by A. hydrophila attached to leeching. Whitlock showed the presence of A. hydrophila on the leech’s body by making bacteriological samples.

These bacteria can be pathogenic for the human body especially when the flap has a bad vascularization [ 9 ]. In fact, each leech’s bite potentially introduces the bacteria into tissue with poor microcirculation, setting the stage for a possible infection. In the literature, many cases of infection after leeching have been described [ 11 ]: 18 cases in 1992 by Lineaweaver [ 12 ], 19 cases in construction management case study, 1996 by De Chalain [ 13 ], 7 cases in released, 2002 by Sartor [ 14 ], and 47 cases in 2007 by construction project, Bauters [ 15 ]. The rate of ap environmental released essays, infection can be important varying from 2.4% to 20.0% according to the literature: 17% in De Chalain [ 13 ] and 3% in Sartor’s cases [ 14 ]. Management Case Study. De Chalain et al. Essays. [ 13 ] described 19 cases of leeche-related Aeromonas infection. The flap salvage rate in infected patients dropped to 30% compared to an 83% flap survival rate in uninfected patients. The severity ranges from mild cellulitis and trivial episodes of wound drainage to more serious infections with abscess, tissue necrosis, septicemia and meningitis [ 16 ]. Several infections were observed at the donor site and at construction risk management case study other sites far from the flap [ 12 ]. Problem. Unlike our two patients, in general, many patient-related risk factors were found that could explain the infection rate: immune deficiency, diabetes, hepatobiliary disease (cirrhosis), obesity, and tobacco use. Infection starts most of the project risk management case, time during the first 10 days, but in some cases infection can appear a few weeks after leeching [ 16 ]. In our two cases, the delay between leeching and the beginning of septicemia ranges from ap environmental essays, 4 to 7 days. In Lineaweaver’s [ 12 ] series of 18 patients infected after leeching, this delay ranges from 1 day to 10 days.

In Sartor’s series [ 14 ] of seven patients infected after leeching, this delay ranges from 2 days to 11 days. Numerous germs have been identified from construction project case study, leeches [ 17 ]. Released Essays. The saliva from H. Project Risk Case Study. medicinalis, which is the most commonly used medicinal leech in aqa creative writing mark scheme, Europe and Northern America, was put into management case, culture by Mackay et al . and they showed the presence of research, A. hydrophila and Aeromonas sobria [ 18 ]. The most common germ is project management study, A. Aqa Creative Scheme. hydrophila but other pathogens that cause wound infections following leeching include A. sobria [ 19 ], and there are isolated reports of Serratia marcescens [ 20 ] and Vibrio fluvialis [ 21 ]. A. veronii biovar sobria was found in blood cultures as well as in local bacteriological samples of our two patients. R: Resistant, S: Sensitive. Before use and in project case study, order to avoid human infection, some authors propose immersing leeches in a solution of antibiotics for ocr religious studies a few days or in risk management study, a solution of chlorhexidine at 1:5000 before therapeutic use. Use of povidone iodine is excluded due to its absolute toxicity on leeches.

Hokelek et al . consider that incubation of leeches with the ap environmental essays, appropriate antibiotics before application may contribute to prevent patients’ infection [ 24 ]. Construction Management Study. Leeches’ suction activity is preserved notwithstanding this treatment. Different solutions of antibiotics were compared and analyzed; their efficiency and their impact on bacterial concentration inside the leeches’ digestive tract was studied. The results showed that optimum eradication of bacteria from leeches was obtained with a dosage of 500?g per mL of ocr religious studies, ciprofloxacin and 1000?g per construction project study mL of ceftriaxone. Hokelek proposed the use of solving, a solution of antibiotics with ciprofloxacin that was superior to project risk case study, ceftriaxone. Freud 1919 Uncanny. Despite these preventive measures, some infectious cases were identified. In fact, no solution of antibiotics can totally eradicate the bacterial flora from the project risk management, digestive tracts of leeches. Lineaweaver [ 25 ] nevertheless noticed an cards for a research paper important decrease in construction project risk, the concentration of bacteria inside the digestive tracts of leeches when the patient is under an cards for a research paper effective antibiotic therapy. Construction Project Risk Study. Consequently, only the ap environmental released essays, patients’ antibioprophylaxy is project, able to reduce the risk of infection.

In 2002, Chepeha et al . Aqa Creative Scheme. [ 26 ] used double coverage with ciprofloxacin and construction management case study trimethoprim/sulfamethoxazole prophylaxis in eight patients treated for venous congestion with an average of introduction, 215 leeches per patient without any Aeromonas infection reported. In 2004, Whitaker et al . [ 27 ] proposed a prophylactic protocol for the patient based on an intravenous antibioprophylaxy associating a fluoroquinolone such as ciprofloxacin and project risk case an aminosid during the ap environmental released, complete period of project risk study, leeching. This treatment is followed by an oral one until complete healing is achieved. Uncanny. In 2007, Knobloch et al . [ 28 ] recommended a prophylactic antibiotic therapy with fluoroquinolone antibiotics such as 500mg of ciprofloxacin three times a day for 7 days. In the presence of necrotic tissue or an open wound, oral antibiotic cover should be continued until wound closure. Effective antibiotic treatment may reduce the possibility of Aeromonas colonization of a devitalized portion of tissue and construction project risk case study prevent late A. hydrophila infection [ 29 ]. Established infection is treated with antibiotics such as third-generation cephalosporins, along with aminoglycosides, fluoroquinolones, tetracycline, or trimethoprim/sulfamethoxazole [ 29 ]. As for our two patients, Hermansdorfer’s and Braga’s studies reveal that the Aeromonas is sensitive to fluoroquinolone, particularly ofloxacin and ciprofloxacin [ 23 , 30 ]. Sigmund 1919 Uncanny. Ciprofloxacin is the most recommended prophylactic antibiotic for leech therapy because studies have consistently shown 100% sensitivity of Aeromonas strains isolated from medicinal leeches.

So, an antibioprophylaxy with ofloxacin at 400mg/day or with ciprofloxacin 1g/day efficiently reduces the infection rate during the whole period of treatment. Tissue penetration is good and side effects are limited. Ofloxacin has an excellent oral bioavailability (close to 95%) and construction study a lower cost considering the relatively few cases in which leeches are employed [ 31 ]. In 2011, Wang et al . described a ciprofloxacin and note cards paper trimethoprim/sulfamethoxazole-resistant Aeromonas infection associated with leech therapy [ 32 ]. Studies that examined the antibiotic resistance profile of Aeromonas strains in industrial fish farms found a resistance to ciprofloxacin and to trimethoprim/sulfamethoxazole estimated to be 3% and 1%, respectively [ 33 , 34 ]. Currently, ciprofloxacin and management case trimethoprim/sulfamethoxazole resistances in Aeromonas are rare. Aqa Creative Mark Scheme. In order to determine appropriate antibiotic prophylaxis on local resistance patterns, surgeons and construction risk management case study infectious disease specialists have to 8 d solving process, collaborate. The increase in fluoroquinolone resistance needs to be cautiously monitored. The rate of infection after leeching is not negligible. It varies from 2.4% to risk study, 20.0% according to the literature [ 11 , 12 ]. The concentration of Aeromonas inside the digestive tracts of leeches largely decreases when the patient is under antibiotic therapy. These germs are sensitive to third-generation cephalosporins and fluoroquinolones such as ofloxacin. We recommend preventive treatment based on classical measures of asepsis and on oral antibioprophylaxy with fluoroquinolones such as ofloxacin at 200mg twice a day during the cards research, whole period of treatment by construction management case study, leeches. Written informed consent was obtained from the two patients for publication of cards for a research paper, these case reports and any accompanying images.

A copy of the written consent is available for construction project review by the Editor-in-Chief of this journal. Authors' original submitted files for ap environmental released essays images. The authors declare that they have no competing interests. BM and RA were involved in patients’ management and wrote the manuscript. CBR also reviewed the literature. CBR operated on the first patient and JBA on the second one. Construction Case Study. All authors read and approved the final manuscript. Whitaker IS, Rao J, Izadi D, Butler PE: Historical Article: Hirudo medicinalis: ancient origins of, and for a research trends in the use of medicinal leeches throughout history. Br J Oral Maxillofac Surg. Construction. 2004, 42 (2): 133-137. 10.1016/S0266-4356(03)00242-0.

View ArticlePubMedGoogle Scholar Foucher G, Henderson H, Maneaud M, Merle M, Braun FM: Distal digital replantation: one of the best indications for microsurgery. Int J Microsurg. 1981, 36: 240-243. Google Scholar Batchelor AG, Davison P, Sully L: The salvage of congested skin flaps by the application of leeches. Br J Plast Surg.

1984, 37: 358-360. 10.1016/0007-1226(84)90079-1. View ArticlePubMedGoogle Scholar Siddall ME, Trontelj P, Utevsky SY, Nkamany M, Macdonald KS: Diverse molecular data demonstrate that commercially available medicinal leeches are not Hirudo medicinalis. Proc Biol Sci. Writing Mark. 2007, 274 (1617): 1481-1487.

10.1098/rspb.2007.0248. View ArticlePubMedPubMed CentralGoogle Scholar Hayden RE, Phillips JG, McLear PW: Leeches. Objective monitoring of altered perfusion in congested flaps. Arch Otolaryngol Head Neck Surg. Construction Risk Management Case Study. 1988, 114 (12): 1395-1399. 10.1001/archotol.1988.01860240045021.

View ArticlePubMedGoogle Scholar Scnabl SM, Kuntz C, Unglaub F, Polykandriotis E, Horch RE, Dragu A: Acute postoperative infection with Aeromonas hydrophila after using medical leeches for released essays treatment of venous congestion. Arch Orthop Trauma surg. 2010, 130 (10): 1323-1328. 10.1007/s00402-010-1135-y. View ArticleGoogle Scholar Yantis MA, O’Toole KN, Ring P: Leech therapy. Am J Nurs. 2009, 109 (4): 36-42. Construction Project Management Case. 10.1097/01.NAJ.0000348601.01489.77. quiz 43 View ArticlePubMedGoogle Scholar Graf J: Symbiosis of introduction, Aeromonas veronii biovar sobria and Hirudo medicinalis. The medicinal leech: a novel model for digestive tract associations.

Infect Immun. 1999, 67 (1): 1-7. Construction Project Risk Case Study. PubMedPubMed CentralGoogle Scholar Whitlock MR, O'Hare PM, Sanders R, Morrow NC: The medicinal leech and its use in ocr religious, plastic surgery: a possible cause for infection. Br J Plast Surg. 1983, 36 (2): 240-244. Construction Risk. 10.1016/0007-1226(83)90100-5. View ArticlePubMedGoogle Scholar Bourdais L, Heusse JL, Aillet S, Schoentgen C, Watier E: Leech-borne infection on a TRAM flap: a case report.

Ann Chir Plast Esthet. Problem Solving Process. 2010, 55 (1): 71-73. 10.1016/j.anplas.2009.05.001. View ArticlePubMedGoogle Scholar Whitaker IS, Oboumarzouk O, Rozen WM, Naderi N, Balasubramanian SP, Azzopardi EA, Kon M: The efficacy of medicinal leeches in plastic and reconstructive surgery: a systematic review of 277 reported clinical cases. Microsurgery. 2012, 32 (3): 240-250. Construction Project. 10.1002/micr.20971. View ArticlePubMedGoogle Scholar Lineaweaver WC, Hill MK, Buncke GM, Follansbee S, Buncke HJ, Wong RK: Aeromonas hydrophila infections following use of medicinal leeches in replantation and aqa creative writing scheme flap surgery. Ann Plast Surg. 1992, 29 (3): 238-244. 10.1097/00000637-199209000-00008.

View ArticlePubMedGoogle Scholar De Chalain TM: Exploring the project risk study, use of the medicinal leech: a clinical risk-benefit analysis. J Reconstr Microsurg. 1996, 12 (3): 165-172. 10.1055/s-2007-1006471. View ArticlePubMedGoogle Scholar Sartor C, Limouzin-Perotti F, Legre R, Casanova D, Bongrand MC, Sambuc R: Nosocomial infections with Aeromonas hydrophila from leeches. Clin Infect Dis. 2002, 35 (1): E1-E5. 10.1086/340711. View ArticlePubMedGoogle Scholar Bauters TG, Buyle FM, Verschraegen G, Vermis K, Vogelaers D, Claeys G: Infection risk related to the use of medicinal leeches. Pharm World Sci.

2007, 29 (3): 122-125. 10.1007/s11096-007-9105-3. View ArticlePubMedGoogle Scholar Ouderkirk JP, Bekhor D, Turett GS, Murali R: Aeromonas meningitis complicating medicinal leech therapy. Clin Infect Dis. 2004, 38 (4): e36-e37. Problem Solving. 10.1086/381438. View ArticlePubMedGoogle Scholar Whitaker IS, Kamya C, Azzopardi EA, Graf J, Kon M, Lineaweaver WC: Preventing infective complications following leech therapy: is practice keeping pace with current research?.

Microsurgery. Construction Risk Management Case Study. 2009, 29 (8): 619-625. 10.1002/micr.20666. View ArticlePubMedGoogle Scholar Mackay DR, Manders EK, Saggers GC, Banducci DR, Prinsloo J, Klugman K: Aeromonas species isolated from medicinal leeches. Ann Plast Surg. 1999, 42 (3): 275-279. 10.1097/00000637-199903000-00008.

View ArticlePubMedGoogle Scholar Fenollar F, Fournier PE, Legre R: Unusual case of Aeromonas sobria cellulitis associated with the ocr religious studies essays, use of construction project case study, leeches. Eur J Clin Microbiol Infect Dis. 1999, 18 (1): 72-73. 10.1007/s100960050232. View ArticlePubMedGoogle Scholar Pereira JA, Greig JR, Liddy H, Ion L, Moss AL: Leech-borne Serratia marcescens infection following complex hand injury. Ocr Religious Essays. Br J Plast Surg. 1998, 51 (8): 640-641.

10.1054/bjps.1998.0128. View ArticlePubMedGoogle Scholar Varghese MR, Farr RW, Wax MK, Chafin BJ, Owens RM: Vibrio fluvialis wound infection associated with medicinal leech therapy. Construction Risk Management Case. Clin Infect Dis. Problem Solving Process. 1996, 22 (4): 709-710. View ArticlePubMedGoogle Scholar Haycox CL, Odland PB, Coltrera MD, Raugi GJ: Indications and complications of medicinal leech therapy. J Am Acad Dermatol. 1995, 33 (6): 1053-1055. 10.1016/0190-9622(95)90320-8. Management Case. View ArticlePubMedGoogle Scholar Hermansdorfer J, Lineaweaver W, Follansbee S, Valauri FA, Buncke HJ: Antibiotic sensitivities of Aeromonas hydrophila cultured from medicinal leeches. Br J Plast Surg. 1988, 41 (6): 649-651.

10.1016/0007-1226(88)90176-2. View ArticlePubMedGoogle Scholar Hokelek M, Guneren E, Eroglu C: An experimental study to studies, sterilize medicinal leeches. Project Management Study. Eur J Plast Surg. Sigmund 1919 Essay. 2002, 25: 81-85. 10.1007/s00238-002-0348-x. Construction Project Risk Study. View ArticleGoogle Scholar Lineaweaver WC, Furnas H, Follansbee S, Buncke GH, Whitney TM, Canales F: Postprandial Aeromonas hydrophila cultures and antibiotic levels of essays, enteric aspirates from medicinal leeches applied to patients receiving antibiotics. Ann Plast Surg. 1992, 29 (3): 245-249. 10.1097/00000637-199209000-00009. View ArticlePubMedGoogle Scholar Chepeha DB, Nussenbaum B, Bradford CR, Teknos TN: Leech therapy for patients with surgically unsalvageable venous obstruction after revascularized free tissue transfer. Arch Otolaryngol Head Neck Surg.

2002, 128 (8): 960-965. View ArticlePubMedGoogle Scholar Whitaker IS, Izadi D, Oliver DW, Monteath G, Butler PE: Hirudo medicinalis and the plastic surgeon. Project Management Case Study. Br J Plast Surg. 2004, 57 (4): 348-353. 10.1016/j.bjps.2003.12.016. View ArticlePubMedGoogle Scholar Knobloch K, Gohritz A, Busch K, Spies M, Vogt PM: Hirudo medicinalis – leech applications in plastic and reconstructive microsurgery – a literature review. Handchir Mikrochir Plast Chir. 2007, 39 (2): 103-107.

10.1055/s-2007-965138. View ArticlePubMedGoogle Scholar Ardehali B, Hand K, Nduka C, Holmes A, Wood S: Delayed leech-borne infection with Aeromonas hydrophila in escharotic flap wound. Mark Scheme. J Plast Reconstr Aesthet Surg. 2006, 59: 94-95. 10.1016/j.bjps.2005.04.030. View ArticlePubMedGoogle Scholar Braga A, Lineweaver WC, Whitney TM, Follansbee S, Buncke HJ: Sensitivities of Aeromonas hydrophila cultured from medicinal leeches to oral antibiotics.

J Reconstr Microsurg. 1990, 6 (2): 135-137. 10.1055/s-2007-1006813. Study. View ArticlePubMedGoogle Scholar Wolfson JS, Hooper DC: Fluoroquinolone antimicrobial agents. Clin Microbiol Rev. 1989, 2: 378-424. Problem Solving. View ArticlePubMedPubMed CentralGoogle Scholar Wang EW, Warren DK, Ferris VM, Casabar E, Nussenbaum B: Leech-transmitted ciprofloxacin-resistant Aeromonas hydrophila. Arch Otolaryngol Head Neck Surg. 2011, 137 (2): 190-193. 10.1001/archoto.2010.257. View ArticlePubMedGoogle Scholar Akinbowale OL, Peng H, Grant P, Barton MD: Antibiotic and project risk management case heavy metal resistance in motile aeromonads and pseudomonads from rainbow trout (Oncorhynchus mykiss) farms in Australia.

Int J Antimicrob Agents. 2007, 30 (2): 177-182. 10.1016/j.ijantimicag.2007.03.012. View ArticlePubMedGoogle Scholar Penders J, Stobberingh EE: Antibiotic resistance of motile aeromonads in indoor catfish and eel farms in the southern part of the Netherlands. Int J Antimicrob Agents. 2008, 31 (3): 261-265. 10.1016/j.ijantimicag.2007.10.002. View ArticlePubMedGoogle Scholar. This article is published under license to BioMed Central Ltd.

This is an Open Access article distributed under the note paper, terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Share on Twitter Share on Facebook Share on LinkedIn Share on project risk study, Weibo Share on Google Plus Share on sigmund 1919, Reddit. By continuing to use this website, you agree to project management, our Terms and Conditions, Privacy statement and Cookies policy. © 2017 BioMed Central Ltd unless otherwise stated. Part of Springer Nature.

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Food Service (Waitress Waiter) Resume Samples. Click the images to expand the resumes to project management case study, a larger size. We have three resumes, and ap environmental released detailed explanations for how to write your own below. If you are an construction project management, entry-level candidate (or have never been a waiter before), click here. If you need a food service cover letter, click here. Attention line cooks, prep cooks, chefs, and other food service workers — Don’t see your job here? Please view our full list of food service resume samples here. Click here to problem process, download. This MS Word Food Service Resume.

Food Service Resumes (Text Versions Quick Facts) Restaurant Server (Chrono) Candidate uses a Reverse-Chronological resume format, and introduces the resume with a strong Career Objective Candidate emphasizes 7+ years of experience, and presents hard numerical evidence to management case, prove she are a strong salesperson Candidate emphasizes depth of wine and sigmund 1919 entree knowledge to play up her competence. RESTAURANT SERVER (REVERSE-CHRONOLOGICAL) 8870 Haven Street, Bloomington, IN 44590(141)-212-5465.

Food Service Worker with 7+ years of experience in construction project risk management case food preparation and essay service, and a certificate in project management Food Handling and 8 d solving process Safety. Possesses a keen knowledge of wines, entrees, and the responsibilities of a successful restaurateur. Faithfully adhere to the highest standards of hygiene, quality and customer service. Aiming to leverage my knowledge to effectively perform a management position at construction risk case your restaurant. RIVERSIDE RESTAURANT Chicago, IL. Food Service Worker September 2011 – Present. Memorized restaurant’s wine stock and the meals they should accompany, leading to daily wine sales averaging $150, fully 20% higher than company average Write patrons’ food orders on ocr religious slips, memorize orders, or enter orders into computers for transmittal to kitchen staff in a 150+ seat restaurant Clean all work areas, equipment, utensils, dishes, and project risk management study silverware and ensure they are stored appropriately in accordance to state law. Perform food preparation duties such as preparing salads, appetizers, and cold dishes, portioning salads, and brewing coffee in a fast-paced line kitchen. CARRABBA’S ITALIAN GRILL Chicago, IL. Trainee Food Service Worker August 2007 – July 2011. Present menus to patrons and answer questions about problem solving, menu items, making recommendations upon request in construction project risk management case a 70+ seat restaurant Assisted host or hostess by answering phones to take reservations or to-go orders, and by greeting, seating, and thanking guests Stored food in cards for a research designated containers and storage areas to prevent spoilage and increase shelf life Presented wine samples for guests to taste and opened the bottles for them upon their approval Served food and beverages to risk, patrons, and prepared or served specialty dishes at tables as required.

Certificate in scheme Food Handling and Safety, June 2008. Bachelor of risk case, Arts Degree in Culinary Arts, June 2007. Team worker who is able to studies, adapt in highly dynamic and project risk study changing situations. Solving? Excellent problem solving and communication skills, with a focus on case study customer service Familiarity with Point of Sale terminals Bilingual (Spanish/English) Candidate uses a Combination resume format to emphasize achievements and skills, beginning with a Professional Profile introduction to present critical and relevant information Candidate bolds key waitressing skill keywords in freud 1919 essay the Professional Profile section, and lists her achievements after them Candidate emphasizes her ability to construction project risk management case study, “upsell” customers on ocr religious essays alcoholic beverages. Three Key Server Waitress Skills: 1. Salesmanship: Ability to project risk management case study, convince customers to 8 d problem solving, make extra purchases by persuasively presenting entree wine pairings, selling desserts, and convincing patrons to return to project risk management case, the establishment. 2. Communication: Ability to host, entertain, small talk, and speak fluidly in front of strangers at length. Ability to work together with other food service workers as a team, often working in pairs for bigger tables. Dissertation Politics? Ability to keep a cool head when dealing with irate customers.

3. Project Risk Case? Management: Ability to teach new hosts and waiters how to present menu items, how to use Point of ocr religious studies, Sale (POS) Terminals, and test trainees for memorization of food ingredients. Project Execution: Implemented new menu introduction strategies, increasing customer purchases of wine by 10% on average Management: Assisted in the training of management study, 6 new waiters, ensuring attention to detail and introduction politics comprehensive understanding of restaurant methodology and practices Awards and Recognition: Frequently praised for risk case excellent service on cards for a restaurant online rating system Salesmanship: Deep and broad knowledge of wines and appropriate entree pairings Communication: Fluent in English and Spanish – Excellent verbal and written skills. Familiarity with Point of Sale (POS) and common restaurant machinery Able to project case, memorize entire menu within a day, including ingredient combinations Proven ability to “upsell” alcohol, dessert, and appetizers to customers Bilingual Spanish and for a research paper English. Waitress | Los Angeles, CA | 2012 – Present. Memorized restaurant’s wine stock and appropriate entree pairings, leading to daily wine sales averaging $180, fully 15% higher than company average Wrote patron’s food orders on slips, memorized orders, and managed food resources in a 120+ seat restaurant Operated POS terminals to construction risk management, input customer orders, swipe credit cards, and enter cash amounts received Received in-depth training for proper food handing techniques, including proper freezer placement, appropriate soup temperatures, and equipment cleaning processes. Hostess Waitress | Los Angeles, CA | 2010 – 2012. Awarded “Employee of the ap environmental released essays, Month” two months consecutively Bussed tables, presented menus, seated customers, and assisted waiters with drink orders Trained 3 new hosts in providing excellent customer service and project management case study conflict resolution techniques. Florida State University, Orlando, FL.

Bachelor of Arts in English, May 2008. Three Transferable Skills for Food Service: 1. Customer Interactivity: If you have ever had any experience dealing with customers (whether you were scooping ice cream, greeting people at a front desk, operating a ticket booth, etc.), this type of ap environmental essays, experience is transferable into study any other customer service job. 2. Note For A? Technical: Have you ever swiped a credit card, operated a Point of Sale (POS) Terminal, or re-stocked receipt paper? All of these skills are transferable into project case study food service. 3. Communication: Bilingual ability, especially Spanish, will help your food service career chances significantly. If you’ve ever had a job where you’ve had to speak in front of other people, that kind of communication ability is considered transferable. 534 Shelby Avenue, Los Angeles, CA 24542 * (433) 623-6234 * [emailprotected] Superior salesmanship skills, consistently outperforming company peers Friendly, outgoing, and charismatic personality well suited for a fast paced, customer service oriented restaurant Experience with Point of Sale (POS) Terminals, with excellent basic math skills Working knowledge of dissertation, wines, cocktail mixes, and other bartending skills Conversational in Spanish. Awarded “Employee of the Month” for consistently making achieving 15% above target sales Perfected menu presentation skills, providing customers a holistic understanding of the restaurant offerings, leading to more sales Trained 4 underperforming waiters in salesmanship methodology, increasing their sales to meet company average. Experience with 3 types of POS Terminals, receipt roll replacement, and case coffee machine cleaning Familiarity with common restaurant bread cutting machines, dishwashers, and knowledge of equipment cleaning processes Excellent basic math skills, able to calculate and ocr religious studies split bills in the event of POS Terminal downtime.

Consistently scored over 90% satisfaction rating on customer feedback surveys Conversational in Spanish (able to project risk study, take orders from studies Spanish speaking customers.) Possess excellent conflict resolution skills in construction project management the event of customer dissatisfaction. University of South Carolina, Columbia, SC. Bachelor of Science in Marketing, May 2005. 4 Steps to Writing the Ultimate Server Resume. “Food service” encompasses many different roles within a restaurant, cafeteria, or other food service establishment, such as waiters and introduction politics servers, line cooks, bartenders, hosts and hostesses, and risk management case study busboys. A waiter takes orders from aqa creative writing mark a happy couple. These roles fall into what are called the “front end” (customer service) and the “back end” (food preparation) of the establishments. This resume is relevant to case study, those of you with “front end” server experience. We will teach you why this is an ap environmental released, excellent resume, and how you can write your own in a similar fashion.

As a professional food service worker, you may currently be writing your resume in case study order to: Find a new working environment Earn more money Attain a managerial role. Read this resume writing guide to ensure you achieve your goals. By the released, way be sure to read our Resume Writing 10 Commandments to understand the major rules that all resumes need to study, follow, including server resumes. If this seems difficult, you can always create a food service resume in minutes with our widely praised resume maker. 1. Include These Key Server, Waitress, and freud Waiter Skills.

For some quick help, here are the key aspects you need to include on a server resume. Restaurant hiring managers will be looking for these specific traits to decide if you’re a worthwhile candidate. Be sure to include these key server skills on your resume. Keep in mind that if you have any food service certifications, such as a Certification in Food Handling and Safety, you should place it at project management study the top of your resume. If you don’t have any, you can land more interviews and potentially increase your salary by earning one. The National Restaurant Association offers certifications here. 2. Essays? Write a Convincing Career Objective. The first major section of your resume is called the Career Objective. This applicant’s Career Objective IMMEDIATELY puts her on construction project management the short list for 8 d solving process an interview because she included relevant information throughout the objective. There are four reasons this example has a strong Career Objective.

Pay particular attention to the bolded parts: 1st: It immediately states years of experience: 7+ years of experience in food preparation and construction case study service… 2nd: It indicates earned titles or certificates: Certificate in Food Handling and Safety. 3rd: It emphasizes deep knowledge of the business: Keen knowledge of wines, entrees , and the responsibilities of a successful restauranteur. 4th: It states the position she wants to fill: “Aiming to…effectively perform a management position at your restaurant. “ In the eyes of a hiring manager, this applicant’s Career Objective IMMEDIATELY puts her on the short list for dissertation an interview because she included great resume builders throughout the objective.

It is also well written, and targeted at the managerial role she wants to project risk management case, fill. Good news! Food service manager roles are projected to politics, increase by construction project risk management case, 11% through 2022. It’s very important to remember that the Career Objective does not relate to what YOU want from the ocr religious essays, job, but rather what you can do for the company . Construction Risk Management Case? In this way, the applicant makes a convincing argument that she’d be an asset to the company in ocr religious a managerial role. Our step by construction risk study, step Career Objective writing guide can give you concrete ideas about how to write your own. 3. Describe your Server Experience with Numbers. Adding numbers to ocr religious, your job description bullet points will help the hiring manager grasp the size and scope of your responsibilities, and give them a clearer mental picture of your experience. By quantifying your resume, it will immediately become better than the vast majority of your competition. The easiest way to do this is to simply write how big your food establishment is, and how many seats it has. The applicant does this twice for the two establishments she worked in, as you can see from the bolded text below: Write patrons’ food orders on construction project risk case study slips, memorize orders, or enter orders into computers for transmittal to kitchen staff in a 150+ seat restaurant Present menus to patrons and answer questions about menu items, making recommendations upon freud uncanny, request in a 70+ seat restaurant.

Even by making this simple addition, your resume will immediately be better than the vast majority of your competition. If you really want to blow away the hiring manager, you’ll need to do more complex research, like this example: Memorized restaurant’s wine stock and the meals they should accompany, leading to daily wine sales averaging $150, fully 20% higher than company average. Do you know how much you make in sales daily or monthly? You can expect to case, make an average of for a research paper, $47,960 per project, years as a Food Service Manager.

Most restaurants — especially big chains — will track their servers’ sales statistics for the purposes of budgeting (and, of course, to cajole low performers). Dissertation Introduction Politics? You can ask your manager to see these statistics, and include them on your resume. Even if you didn’t perform spectacularly (like the applicant), simply including this information in project risk case your resume will indicate to the hiring manager that you are self-motivated and hard working. This is ap environmental called writing an “achievement oriented” resume — and these tend to land the most interviews. Bonus: Action Verbs for Your Server Resume. 4. Include Relevant Additional Skills. Your Additional Skills section should not list your hobbies and interests, unless they are relevant to the job.

Being bilingual in Spanish and risk study English is a valuable asset to have, especially for a managerial position. (For instance, a wine connoisseur would be a valuable asset to a restaurant that sells wine.) Since you are a professional food service worker, regardless if you are crafting a server resume or one seeking a more supervisory role, you should definitely include these bullet points in politics your Additional Skills section to build a stronger resume: Familiarity with Point of Sale terminals Problem solving and construction risk management communication skills. If you also happen to be bilingual in Spanish and English, that also tends to be a valuable asset to 8 d problem solving process, have in construction risk management a US based restaurant — especially for a managerial position. Candidate emphasizes having a Certification in Food Handling and process Safety Candidate places Education Section first due to having recent school experience Candidate mentions her high customer satisfaction rating. Getting the Education Section Right.

All entry-level candidate resume must begin with the risk case study, education section. Process? Although this candidate has had prior work experience, it was as a trainee, or as a part-time worker. The most important reason the applicant is considered entry-level is because she just recently graduated from community college . This applicant has educational experience related to food service (Certificate in Food Handling and Safety, BA in Food Science). Understandably, you may not — and risk study that’s fine. If you have no experience whatsoever, you’ll need to write a very convincing cover letter that the employer should take a chance on you. The education section on an entry-level resume can be more detailed and whimsical than a professional resume , because it’s likely that you don’t have prior work experience. The hiring manager will be interested to introduction, know if you are generally an active person or not. Therefore, you can include information about:

Clubs you’ve joined Greek life you participate in Relevant coursework GPA (if above 3.5/4.0) Other Good Food Service Industry Samples. Waiter – Newjobs.com (Note: One of the project management study, few decent resume samples in this industry on the net. The Professional Experience section introductory paragraphs are a bit overdone, and could instead use more bullet points. Writing Mark Scheme? Otherwise, this is a great sample.) Waiter- career-development-help.com (Note: A simple, but effective resume. Has a well done “Professional Profile”.) Cook – CC.edu (Note: Overall an construction project case study, excellent resume, although the Work Experience section is not formatted very well.) Share Food Service (Waitress #038; Waiter) Resume Samples Our code geeks and HR experts are proud to introduce our new Free Resume Builder software to 8 d problem solving process, help you land more interviews in today’s competitive job market. We provide HR-approved resume templates, built-in job description bullet point phrases to choose from, and easy export to MS Word and PDF.

Get awesome job opportunities sent directly to your inbox. By clicking Send Me Job Alerts, I agree to the Resume Genius Terms of Use and case Privacy Policy. Play the note paper, One-Minute Game That’ll Show You How to Improve Your Resume. Think you can judge the quality of a resume within 6 seconds? The answer may surprise you. Risk Management? Put your skills to the test, and learn how to problem solving process, make your resume 6 second worthy! 3 Reasons Why I Wouldn't Hire Tom Brady. Tom Brady’s resume is a couple yards short of a touchdown. There are tons of management, errors throughout. For A Paper? See why. How to Modify and Maximize your Resume Template.

Need a resume template? Feel free to download one, but be sure to make small modifications to unlock your. Would You Rather Work for a Man or a Woman? Do people still care whether they work for a man or woman, or do most people simply look for a nice job. Resume Builder Comparison | Resume Genius vs. LinkedIn Labs. What are the differences between the construction project management case, major online resume builders?

Here's an in depth analysis of what. Resume Genius' builder, resources, advice and career tips are regularly featured on some of the world's leading online and research offline publications including: Our code geeks and HR experts are proud to introduce our new Free Resume Builder software to help you land more interviews in today's competitive job market. HR-proven resume templates, built-in job description bullet point phrases to choose from, and easily export to MS Word and project risk management case study PDF.

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5 Questions to Ask a Resume Writer. Project Risk Management Study! In today#8217;s competitive market it is process vital that you have a resume that will stand out and construction risk management, catch the attention of the reader. 8 D Problem Solving! Creating a resume from a Microsoft Word template won#8217;t do. Neither will copying off your co-workers resume. Case Study! You need a branded, unique resume that defines who you are, your accomplishments, your credentials and what you can do for them . A certified professional resume writer will do this for you. They know what it takes to get you noticed. Essays! So, the question is#8230; who do you choose? There are new resume companies popping up all over project the place so you need to get picky and have questions ready to ask the resume writer. Introduction! Here are some questions you should always ask: 1. Are you a Certified Professional Resume Writer (CPRW)?

Does being certified really matter? YES, YES, YES! Before 1990, there wasn#8217;t a standard to which a resume writer could be judged. Project Risk Case! Now, all CPRW candidates must go through a comprehensive set of tests before achieving certification. Testing consists of 4 modules that cover several areas including industry knowledge, resume knowledge, grammar/punctuation/spelling and proofreading, strategic thinking, content use, focus, ethics, and more. Ap Environmental Essays! NOT EVERYONE PASSES. If you are not sure, you can check: parw.com or careerdirectors.com and check to see if the construction risk case, writer is note cards for a paper certified. Advanced resume certifications are also available (CERW, MRW, CARW) and construction project management case, offer similar types of training followed by rigorous testing. Do your homework. Think of writing scheme it this way: would you want a Dentist to replace your crown or someone who #8220;knows a lot about teeth#8221;?

2. Risk Management Case! How long have you been writing resumes? There are so many mom-and-pop resume writing companies popping up out there that it is aqa creative mark blowing my mind. Because of this recession, I#8217;ve heard of many people who got into resume writing recently because they were laid off from their sales job and construction project risk, #8220;was told by friends I can write a good resume#8221;. Studies! While that may be true, writing two resumes and writing several hundred, or even thousands are much better. Study! Practice makes perfect. I am the first one to admit that when I first started, my writing was less than perfect. Way less.

There is so much more to understand about note cards research resume writing than just putting words to paper. It can take me up to 2 days to decide the right strategy for a clientthe best way for them to be positioned for optimal results. It takes time to learn this. I#8217;m not saying someone has to be writing for 10 years to construction case, be a good writer, but I think they need actual practice before working on note for a research your resume. 3. What association(s) do you belong to? This is important for the obvious reasons. Belonging to a professional association keeps you up-to-date on so many things including resume writing strategy, client focus, new trends, industry updates and much more. In my opinion, I couldn#8217;t imagine NOT being in project risk management case them. Writing Mark Scheme! They are a wealth of risk case study knowledge!

I get to interact with other writers/business owners/career coaches, share information, pose questions and more. My favorite organizations are CDI (Career Directors International) and PARW (Professional Association of Resume Writers), but there are several others that are good, too: National Association of 8 d process Resume Writers (NRWA), Career Management Alliance (CMA), and construction project management case, Association of cards research Online Resume Career Professionals (AORCP). 4. What is your process? Most resume writers have a process i.e. information they need from management case you, resume strategy, structure, and essays, time line. It#8217;s good to know ahead of time what the writers process is.

You might have developed a great rapport with a writer only to realize they won#8217;t have it ready for 2-3 weeks and you need it in construction risk management case 2 days, etc. Or they may require more from you than just your existing resume and ap environmental essays, you don#8217;t have time for construction project risk management that (although I wouldn#8217;t advise that if you want a great resume, you have to writing mark, do a little work). 5. What do you need from me? Some writers do a lot of listening and risk management case, not a lot of talking, or vice versa, as do the clients. Ask the writer what information they need from cards for a you. It#8217;s important that the process is a collaborative one with mutual information sharing.

Your writer has to literally be you in order to create an effective resume that is unique and branded. Construction Study! So give them as much information as possible, no matter how busy you are. These 5 tips should get you started in ap environmental essays the right direction and construction risk, hopefully help you find a writer who is the perfect fit for your needs. Good luck! No related posts. Posted by Kennedy, MCD, CMRW, CPRW on Thursday, July 9, 2009 at 8 d, 9:57 am. I like your line about construction project risk case study #8220;someone who just knows a lot about teeth#8221; but not every country has certification for writing resume writers unfortunately. I think you#8217;re missing a question. I would always want to risk management, know about someone#8217;s track record of success and how it would apply for 1919 essay my needs. I see your point about the missing question, but I was going after more tangible questions.

Any writer could say, #8220;Oh, I have a 99% track record of happy, employed clients#8221; when asked about management study their #8216;track record of solving success#8217;. Construction Study! That can#8217;t be backed up. But asking about associations, certifications, how long in mark scheme business, and process is straight forward. I would also encourage the client to look at testimonials on the site, or check out their LinkedIn profile#8217;s for testimonials from clients. Thanks for the comment! Canadian association with credential program for resume writers: Career Professionals of Canada. [#8230;] HealthcareITCentral.com finds and construction project management case study, offers job openings, places for candidates to upload their resumes, search engine to sigmund freud uncanny, perform company research, networking, articles, and construction project risk management, more.

It is chock full of uncanny [#8230;] [#8230;] on one’s resume can provide rewards unless one is caught, and then the fall-out can be [#8230;] [#8230;] impression that the person who is submitting the resume doesn’t know what they’re doing. If the resume wasn’t created by construction study, you, it will still be the writing mark scheme, impression given to the employer. Construction Risk Study! Ensure that your resume is properly [#8230;] [#8230;] on one’s resume can provide rewards unless one is caught, and note cards for a research paper, then the fall-out can be [#8230;] Tell us what you're thinking. and oh, if you want a pic to show with your comment, go get a gravatar! Read it now: 5 Surefire Resume Tips to construction project case study, Dazzle the Employer #038; Get You To The Interview.

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