RESUMEN
We describe a ceftriaxone-resistant Salmonella Typhi bacteraemia in a pregnant woman returning from a family visit in Pakistan. Whole genome sequencing confirmed similarity to a Pakistani outbreak clone. Pregnancy and unawareness of this outbreak delayed appropriate antibiotic therapy. Concurrently, we detected faecal carriage of a carbapenemase-producing Escherichia coli. Awareness of the ongoing outbreak should affect empiric treatment of typhoid fever and hygiene precautions in travellers returning from Pakistan. Meropenem may be warranted in severe cases.
Asunto(s)
Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Ceftriaxona/farmacología , Meropenem/uso terapéutico , Salmonella typhi/genética , Salmonella typhi/aislamiento & purificación , Fiebre Tifoidea/diagnóstico , Fiebre Tifoidea/tratamiento farmacológico , Dolor Abdominal/etiología , Adulto , Pruebas de Aglutinación , Antibacterianos/farmacología , Bacteriemia/tratamiento farmacológico , Enterobacteriaceae Resistentes a los Carbapenémicos , Ceftriaxona/uso terapéutico , Dinamarca , Resistencia a Medicamentos , Escherichia coli/genética , Escherichia coli/aislamiento & purificación , Femenino , Fiebre/etiología , Humanos , Pruebas de Sensibilidad Microbiana , Pakistán , Plásmidos/análisis , Reacción en Cadena de la Polimerasa , Embarazo , Salmonella typhi/efectos de los fármacos , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Viaje , Fiebre Tifoidea/microbiología , Secuenciación Completa del GenomaRESUMEN
We describe a multidrug-resistant Neisseria gonorrhoeae infection with ceftriaxone resistance and azithromycin intermediate resistance in a heterosexual man in Denmark, 2017. Whole genome sequencing of the strain GK124 identified MSLT ST1903, NG-MAST ST1614 and all relevant resistance determinants including similar penA resistance mutations previously described in ceftriaxone-resistant gonococcal strains. Although treatment with ceftriaxone 0.5 g plus azithromycin 2 g was successful, increased awareness of spread of gonococcal strains threatening the recommended dual therapy is crucial.