A case of Extensively Drug Resistant (XDR) Extended Spectrum Beta-Lactamase (ESBL) typhoid fever in the Ambulatory Emergency Care (AEC) unit

Background: An outbreak of Extensively Drug Resistant (XDR) Salmonella Typhi (S. Typhi) has recently emerged from Pakistan. The strain is resistant to most first-line antibiotics, including cephalosporins, and has become a significant public health threat due to limited treatment options. We report...

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Main Authors: Amelia Benjamin, Louise Olley, Oliver Troise, Stephen Hughes, Hugo Donaldson, Ashkan Sadighi
Format: Article
Language:English
Published: Elsevier 2021-04-01
Series:Clinical Infection in Practice
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S2590170221000054
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spelling doaj-8dfbe0df28b949dbb59eff4524ea9ae32021-04-04T04:20:23ZengElsevierClinical Infection in Practice2590-17022021-04-0110100068A case of Extensively Drug Resistant (XDR) Extended Spectrum Beta-Lactamase (ESBL) typhoid fever in the Ambulatory Emergency Care (AEC) unitAmelia Benjamin0Louise Olley1Oliver Troise2Stephen Hughes3Hugo Donaldson4Ashkan Sadighi5Chelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UK; Corresponding author at: Newham General Hospital, Plaistow, London E13 ESL, UK.Chelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UKChelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UKChelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UKChelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UK; North West London Pathology, Imperial College Healthcare NHS Trust, Hammersmith Campus, London, UK; Imperial College London, London, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UKChelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UK; Imperial College London, London, UKBackground: An outbreak of Extensively Drug Resistant (XDR) Salmonella Typhi (S. Typhi) has recently emerged from Pakistan. The strain is resistant to most first-line antibiotics, including cephalosporins, and has become a significant public health threat due to limited treatment options. We report one such case of S. Typhi in a 48-year-old female presenting to our West London ambulatory emergency care department. Case Report: The patient, who had recently travelled to Pakistan, presented with symptoms of a dry cough, fever, maculopapular rash, and dysuria. Blood cultures initially isolated Salmonella spp, serotype Typhi and empirical ceftriaxone was commenced. Antibiotic sensitivity testing (AST) identified Salmonella spp. ESBL (Extended Spectrum Beta Lactamase-producing) subspecies I (ST1 EBG:13), with cephalosporin and fluoroquinolone resistance (ciprofloxacin MIC 2 mg/L), hence labelling it XDR. It retained susceptibility to meropenem and azithromycin (azithromycin MIC 12 mg/L). An ESBL Escherichia coli was concurrently grown in urine cultures. Once antibiotic sensitivities were available, the patient was converted from ceftriaxone to a course of azithromycin orally and ertapenem intravenously. The patient defervesced promptly, demonstrated blood and urine clearance on follow up and was successful treated. Conclusions: This case report highlights the limitations of ceftriaxone in our empirical management of suspected typhoid fever, especially in those returning from high-risk regions. Increased prevalence of these resistant salmonella will lead to failures of the current treatment practices and continuous surveillance and improving infection control measures are required to mitigate the spread of these XDR S. Typhi. Azithromycin and carbapenems retain in vitro activity and play an important role in treatment of XDR S. Typhi; loss of the organism’s sensitivity to these agents presents a serious public health threat. Further studies are warranted to confirm in vivo efficacy of ertapenem particularly when used as monotherapy.http://www.sciencedirect.com/science/article/pii/S2590170221000054Salmonella TyphiTyphoid feverCeftriaxone-resistanceExtended-spectrum beta-lactamaseESBLMultidrug resistant
collection DOAJ
language English
format Article
sources DOAJ
author Amelia Benjamin
Louise Olley
Oliver Troise
Stephen Hughes
Hugo Donaldson
Ashkan Sadighi
spellingShingle Amelia Benjamin
Louise Olley
Oliver Troise
Stephen Hughes
Hugo Donaldson
Ashkan Sadighi
A case of Extensively Drug Resistant (XDR) Extended Spectrum Beta-Lactamase (ESBL) typhoid fever in the Ambulatory Emergency Care (AEC) unit
Clinical Infection in Practice
Salmonella Typhi
Typhoid fever
Ceftriaxone-resistance
Extended-spectrum beta-lactamase
ESBL
Multidrug resistant
author_facet Amelia Benjamin
Louise Olley
Oliver Troise
Stephen Hughes
Hugo Donaldson
Ashkan Sadighi
author_sort Amelia Benjamin
title A case of Extensively Drug Resistant (XDR) Extended Spectrum Beta-Lactamase (ESBL) typhoid fever in the Ambulatory Emergency Care (AEC) unit
title_short A case of Extensively Drug Resistant (XDR) Extended Spectrum Beta-Lactamase (ESBL) typhoid fever in the Ambulatory Emergency Care (AEC) unit
title_full A case of Extensively Drug Resistant (XDR) Extended Spectrum Beta-Lactamase (ESBL) typhoid fever in the Ambulatory Emergency Care (AEC) unit
title_fullStr A case of Extensively Drug Resistant (XDR) Extended Spectrum Beta-Lactamase (ESBL) typhoid fever in the Ambulatory Emergency Care (AEC) unit
title_full_unstemmed A case of Extensively Drug Resistant (XDR) Extended Spectrum Beta-Lactamase (ESBL) typhoid fever in the Ambulatory Emergency Care (AEC) unit
title_sort case of extensively drug resistant (xdr) extended spectrum beta-lactamase (esbl) typhoid fever in the ambulatory emergency care (aec) unit
publisher Elsevier
series Clinical Infection in Practice
issn 2590-1702
publishDate 2021-04-01
description Background: An outbreak of Extensively Drug Resistant (XDR) Salmonella Typhi (S. Typhi) has recently emerged from Pakistan. The strain is resistant to most first-line antibiotics, including cephalosporins, and has become a significant public health threat due to limited treatment options. We report one such case of S. Typhi in a 48-year-old female presenting to our West London ambulatory emergency care department. Case Report: The patient, who had recently travelled to Pakistan, presented with symptoms of a dry cough, fever, maculopapular rash, and dysuria. Blood cultures initially isolated Salmonella spp, serotype Typhi and empirical ceftriaxone was commenced. Antibiotic sensitivity testing (AST) identified Salmonella spp. ESBL (Extended Spectrum Beta Lactamase-producing) subspecies I (ST1 EBG:13), with cephalosporin and fluoroquinolone resistance (ciprofloxacin MIC 2 mg/L), hence labelling it XDR. It retained susceptibility to meropenem and azithromycin (azithromycin MIC 12 mg/L). An ESBL Escherichia coli was concurrently grown in urine cultures. Once antibiotic sensitivities were available, the patient was converted from ceftriaxone to a course of azithromycin orally and ertapenem intravenously. The patient defervesced promptly, demonstrated blood and urine clearance on follow up and was successful treated. Conclusions: This case report highlights the limitations of ceftriaxone in our empirical management of suspected typhoid fever, especially in those returning from high-risk regions. Increased prevalence of these resistant salmonella will lead to failures of the current treatment practices and continuous surveillance and improving infection control measures are required to mitigate the spread of these XDR S. Typhi. Azithromycin and carbapenems retain in vitro activity and play an important role in treatment of XDR S. Typhi; loss of the organism’s sensitivity to these agents presents a serious public health threat. Further studies are warranted to confirm in vivo efficacy of ertapenem particularly when used as monotherapy.
topic Salmonella Typhi
Typhoid fever
Ceftriaxone-resistance
Extended-spectrum beta-lactamase
ESBL
Multidrug resistant
url http://www.sciencedirect.com/science/article/pii/S2590170221000054
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