First Case of Azithromycin Resistance in Salmonella Typhi, Isolated in a Patient with Prosthetic Valve Replacement

Abstract

Salmonella enterica serovar Typhi (S. Typhi) is one of the typhoidal Salmonellae that causes typhoid fever. We report the first case of an XDR S. Typhi in a suspected case of Endocarditis with Aortic Valve Replacement and deranged INR. The identification was carried out by an automated system. The antibiogram was performed according to CLSI recommendations. The XDR S. Typhi isolates were found resistant to Azithromycin. Although XDR S. Typhi has been reported in our country and elsewhere, however, till to date no complete resistant isolate of S. Typhi to Azithromycin has been reported in Pakistan. The patient had a smooth recovery on intravenous meropenem. The case highlights the importance of the acquisition of resistance to the last line antibiotics in S. Typhi in our country and is of concern to infectious disease specialists to ensure infection control to avoid its spread. J Microbiol Infect Dis 2021; 11(1):32-35.

Keywords

• Salmonella
• XDR S. Typhi
• Azithromycin

References

1. 1. Feasey NA, Dougan G, Kingsley RA, Heyderman RS, Gordon MA. Invasive non-typhoidal Salmonella disease: An emerging and neglected tropical disease in Africa. Lancet 2012; 379(9835):2489-99.
2. 2. Sudhaharan S, Padmaja K, Solanki R, Lakshmi V, Umabala P, Aparna B. Extra-intestinal Salmonellosis in a tertiary care hospital in South India. J Infect Dev Ctries 2014; 8(7):831-7.
3. 3. Crump JA, Luby SP, Mintz ED. The global burden of typhoid fever. Bulletin of the World Health Organization 2004; 82:346-53.
4. 4. Crump JA, Sjölund-Karlsson M, Gordon MA, Parry CM. Epidemiology, clinical presentation, laboratory diagnosis, antimicrobial resistance, and antimicrobial management of invasive Salmonella infections. Clin Microbiol Rev 2015; 28(4):901-937.
5. 5. Olarte J, Galindo E. Salmonella Typhi resistant to chloramphenicol, ampicillin, and other antimicrobial agents: strains isolated during an extensive typhoid fever epidemic in Mexico. Antimicrob Agent Chemother 1973; 4(6):597-601.
6. 6. Klemm EJ, Shakoor S, Page AJ, et al. Emergence of an extensively drug-resistant Salmonella enterica serovar Typhi clone harboring a promiscuous plasmid encoding resistance to fluoroquinolones and third-generation cephalosporins. MBio 2018; 9(1): e00105-18.
7. 7. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. CLSI, Wayne 2018; 28th ed: document M100.
8. 8. Bhatti JM, Memon Y, Sarfaraz S, Salahuddin N. An unusual case of extensively drug resistant typhoid fever. Cureus 2019;11(5).

9. 9. Qamar FN, Yousafzai MT, Khalid M, et al. Outbreak investigation of ceftriaxone-resistant Salmonella enterica serotype Typhi and its risk factors among the general population in Hyderabad, Pakistan: a matched case-control study. The Lancet Infectious Diseases 2018; 18(12):1368-76.
10. 10. Morgenstern R, Hayes PC: The liver in typhoid fever: always affected, not just a complication. Am J Gastroenterol 1991; 86:1235-9.
11. 11. Ramanathan M: Unusual hepatic manifestations in typhoid fever. Singapore Med J 1991; 32:335-7.
12. 12. Chatham-Stephens K, Medalla F, Hughes M, et al. Emergence of Extensively Drug-Resistant Salmonella Typhi Infections Among Travelers to or from Pakistan—United States, 2016–2018. Morbidity and Mortality Weekly Report 2019; 68(1):11.
13. 13. Molloy A, Nair S, Cooke FJ, et al. First report of Salmonella enterica serotype paratyphi A azithromycin resistance leading to treatment failure. Journal of clinical microbiology 2010; 48(12):4655-4657.
14. 14. Hooda Y, Saha S, Sajib MS, et al. Emergence and molecular basis of azithromycin resistance in typhoidal Salmonella in Dhaka, Bangladesh. bioRxiv 2019; 1:594531.
15. 15. Manesh A, Balaji V, Kumar DR, Rupali P. A case of clinical and microbiological failure of azithromycin therapy in Salmonella enterica serotype Typhi despite low azithromycin MIC. Intern J Infect Dis 2017; 54:62-63.