title: Severe infection with multidrug-resistantSalmonella choleraesuisin a young patient with primary sclerosing cholangitis.
abstract: Massive global spread of multidrug-resistant (MDR)Salmonellaspp. expressing extended-spectrum beta-lactamase (ESBL) and additional resistance to fluoroquinolones has often been attributed to high international mobility as well as excessive use of oral antibiotics in livestock farming. However, MDRSalmonellaspp. have not been mentioned as a widespread pathogen in clinical settings so far. We demonstrate the case of a 25-year-old male with primary sclerosing cholangitis who tested positive for MDRSalmonella entericaserotype Choleraesuis expressing ESBL and fluoroquinolone resistance. The pathogen was supposedly acquired during a trip to Thailand, causing severe fever, cholangitis and pancreatitis. To our knowledge, this is the first report ofSalmonella entericaserotype Choleraesuis in Europe expressing such a multidrug resistance pattern. ESBL resistance ofSalmonella entericaspp. should be considered in patients with obstructive biliary tract pathology and travel history in endemic countries.
authors.affiliation: Philip G Ferstl, Stefan Zeuzem, Oliver Waidmann, Georgios Grammatikos, Department for Internal Medicine I/Gastroenterology and Hepatology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany.
authors.forename: Philip G
authors.initials: PG
authors.lastname: Ferstl
authors.affiliation: Philip G Ferstl, Stefan Zeuzem, Oliver Waidmann, Georgios Grammatikos, Department for Internal Medicine I/Gastroenterology and Hepatology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Reinheimer
authors.affiliation: Philip G Ferstl, Stefan Zeuzem, Oliver Waidmann, Georgios Grammatikos, Department for Internal Medicine I/Gastroenterology and Hepatology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany.
authors.forename: Katalin
authors.initials: K
authors.lastname: Jozsa
authors.affiliation: Philip G Ferstl, Stefan Zeuzem, Oliver Waidmann, Georgios Grammatikos, Department for Internal Medicine I/Gastroenterology and Hepatology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Zeuzem
authors.affiliation: Philip G Ferstl, Stefan Zeuzem, Oliver Waidmann, Georgios Grammatikos, Department for Internal Medicine I/Gastroenterology and Hepatology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany.
authors.forename: Volkhard Aj
authors.initials: VA
authors.lastname: Kempf
authors.affiliation: Philip G Ferstl, Stefan Zeuzem, Oliver Waidmann, Georgios Grammatikos, Department for Internal Medicine I/Gastroenterology and Hepatology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Waidmann
authors.affiliation: Philip G Ferstl, Stefan Zeuzem, Oliver Waidmann, Georgios Grammatikos, Department for Internal Medicine I/Gastroenterology and Hepatology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany.
authors.forename: Georgios
authors.initials: G
authors.lastname: Grammatikos
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D005060:Europe; D005334:Fever; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D012480:Salmonella Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D019779:Salmonella enterica / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification / Q000502:physiology*; D065288:Serogroup; D013785:Thailand; D014195:Travel; D014463:Ultrasonography; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole; D002939:Ciprofloxacin; D015378:Imipenem; D001618:beta-Lactamases
keywords: Biliary physiology; Infectious disease; Multidrug resistance; Primary sclerosing cholangitis; Salmonella choleraesuis