title: Development of carbapenem resistance during therapy for non-typhoid Salmonella infection.
abstract: Multidrug-resistant Salmonella infection is a global problem, and carbapenems may represent the last therapeutic choice. We report a case of infection caused by ceftriaxone-resistant and ciprofloxacin-resistant Salmonella enterica serotype Typhimurium. A bla(CMY-2) -containing Tn6092, located on a self-transferable IncI1 plasmid, was found in all isolates derived from the patient. During ertapenem treatment, the strain developed carbapenem resistance. Apart from the OmpD deficiency found in all isolates, the strain further developed OmpC deficiency through a single gene mutation, and became carbapenem-resistant. Salmonella appears to be very plastic in developing antimicrobial resistance. Care must be taken by physicians when treating multidrug-resistant Salmonella infection.
authors.affiliation: Department of Laboratory Medicine  Molecular Infectious Disease Research Centre, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: L H
authors.initials: LH
authors.lastname: Su
authors.forename: T L
authors.initials: TL
authors.lastname: Wu
authors.forename: C H
authors.initials: CH
authors.lastname: Chiu
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015780:Carbapenems / Q000494:pharmacology*; D002939:Ciprofloxacin / Q000494:pharmacology; D024901:Drug Resistance, Multiple, Bacterial; D000077727:Ertapenem; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D008826:Microbial Sensitivity Tests; D010957:Plasmids; D017354:Point Mutation; D018272:Porins / Q000235:genetics; D012329:RNA, Bacterial / Q000235:genetics; D012480:Salmonella Infections / Q000188:drug therapy* / Q000382:microbiology / Q000652:urine; D012486:Salmonella typhimurium / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology; D014946:Wound Infection / Q000188:drug therapy / Q000382:microbiology; D047090:beta-Lactams / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; C113724:OmpC protein; C470933:OmpD protein, Salmonella typhimurium; D018272:Porins; D012329:RNA, Bacterial; D047090:beta-Lactams; D002939:Ciprofloxacin; D000077727:Ertapenem