cefotaxime and Paratyphoid-Fever

Salmonella is a notorious pathogen that causes gastroenteritis in humans and the emergence of resistance to third-generation cephalosporins and azithromycin have raised concern. There has been rare case of Salmonella Paratyphi A infection accompanied by spondylitis. Here, we report a case of initial antibiotic treatment failure in a Korean man with Salmonella Paratyphi A infection and conducted next-generation sequencing (NGS) to determine the cause of failure of initial treatment for Salmonella Paratyphi A infection.. A 70-year-old man was admitted to Chosun University Hospital with reported consistent low back pain with a history of having 5 days of chills and fever in another hospital a month ago. He was administered ceftriaxone (2 g daily) for 18 days including initial treatment to cover Salmonella enterica. The antimicrobial susceptibility test using MIC plate, found that the identified organism was resistant to ciprofloxacin and nalidixic acid. Moreover, the Salmonella Paratyphi A isolates were found to have an MIC > 16 mg/L for azithromycin, as he had resistance to both azithromycin and nalidixic acid, the treatment was switched to a combination of ciprofloxacin and cefotaxime. We carried out next-generation sequencing (NGS) to determine the cause of failure of initial treatment for Salmonella Paratyphi A infection. NGS showed that the amino acid substitution GyrA S83F and the expression of multiple RNA-family efflux pumps led to a high-level resistance to quinolone. No genes related to ceftriaxone resistance, such as CTX-M, CMY-2, or other extended-spectrum beta-lactamases were identified in Salmonella enterica Paratyphi A using NGS. The GyrA S83F mutation and the expression of multiple RNA-family efflux pumps may have contributed to the treatment failure of ceftriaxone, even though the MIC of the isolate to ceftriaxone was less than 1.. This case involved a Salmonella Paratyphi A infection accompanied by spondylitis. To our knowledge, this is the first report to elucidate the mechanism underlying antimicrobial resistance using NGS.

Topics: Aged; Amino Acid Substitution; Anti-Bacterial Agents; Azithromycin; Cefotaxime; Ceftriaxone; Ciprofloxacin; DNA Gyrase; Drug Resistance, Bacterial; High-Throughput Nucleotide Sequencing; Humans; Male; Microbial Sensitivity Tests; Paratyphoid Fever; Salmonella paratyphi A; Treatment Failure

Spontaneous (primary) bacterial peritonitis (SBP) due to S. paratyphi A is relatively uncommon. Clinical manifestations of SBP vary widely from severe to slight or absent, necessitating laboratory investigation of ascitic fluid. The disease is confirmed by number of neutrophils > 250/mm3 associated with or without bacterial growth in ascitic fluid culture from diagnostic abdominal paracentesis. Here, we present a case of S. paratyphi A SBP occurring in a patient with chronic liver disease and portal hypertension.The patient was treated with intravenous cefotaxime with good clinical response.

Topics: Anti-Bacterial Agents; Cefotaxime; Chronic Disease; Esophageal and Gastric Varices; Humans; Hypertension, Portal; Male; Middle Aged; Paratyphoid Fever; Peritonitis; Salmonella paratyphi A

While there are concerns about the consequences of widespread use of quinolones, there are few reports of quinolone-resistant strains of Salmonella typhi or Salmonella paratyphi from the Indian subcontinent. We present a case report of a newborn with meningitis due to a quinolone-resistant strain of S. paratyphi B presenting to the Aga Khan University Hospital (AKUH).

Topics: Amikacin; Anti-Bacterial Agents; Anti-Infective Agents; Brain Abscess; Cefotaxime; Cephalosporins; Ciprofloxacin; Drug Resistance, Multiple; Drug Therapy, Combination; Female; Histocytochemistry; Humans; Imipenem; Infant, Newborn; Infant, Premature, Diseases; Meningitis, Bacterial; Microbial Sensitivity Tests; Paratyphoid Fever; Salmonella paratyphi B; Thienamycins; Tomography, X-Ray Computed

Salmonella paratyphi B is a pathogenic agent causing outbreaks and keeping epidemiologic importance. The classical treatment of this disease is made by ampicillin, chloramphenicol, and co-trimoxazole in resistant strain. The resistant strains tends to cause a treatment problem. We report treatment and antibiogram results of 48 patients exactly diagnosed as paratyphi B infection by clinic and laboratory evaluation. These patients came to pediatric clinic of Erzincan state Hospital from Erzincan town and its backgrounds and had ages between 3 months and 5 years. All isolates were resistant to ampicillin, chloramphenicol and cotrimoxazole but usually sensitive to 3. generation cephalosporins (Cefotaxime had greatest sensitivity ratio with 79.1%) and amikacin.

Topics: Amikacin; Ampicillin Resistance; Cefotaxime; Cephalosporins; Child, Preschool; Chloramphenicol; Drug Resistance, Microbial; Humans; Infant; Paratyphoid Fever; Salmonella; Salmonella paratyphi B; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Aged; Ampicillin; Carrier State; Cefotaxime; Cephalosporins; Cholelithiasis; Female; Humans; Middle Aged; Paratyphoid Fever; Typhoid Fever