Ferstl PG, Reinheimer C, Jozsa K, Zeuzem S, Kempf VA, Waidmann O, Grammatikos G. Severe infection with multidrug-resistant Salmonella choleraesuis in a young patient with primary sclerosing cholangitis. World J Gastroenterol 2017; 23(11): 2086-2089 [PMID: 28373776 DOI: 10.3748/wjg.v23.i11.2086]
Corresponding Author of This Article
Dr. Philip G Ferstl, Department for Internal Medicine I/Gastroenterology and Hepatology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany. philip.ferstl@kgu.de
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Mar 21, 2017; 23(11): 2086-2089 Published online Mar 21, 2017. doi: 10.3748/wjg.v23.i11.2086
Severe infection with multidrug-resistant Salmonella choleraesuis in a young patient with primary sclerosing cholangitis
Philip G Ferstl, Claudia Reinheimer, Katalin Jozsa, Stefan Zeuzem, Volkhard AJ Kempf, Oliver Waidmann, Georgios Grammatikos
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
Claudia Reinheimer, Katalin Jozsa, Volkhard AJ Kempf, Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
Philip G Ferstl, Claudia Reinheimer, Katalin Jozsa, Stefan Zeuzem, Volkhard AJ Kempf, Oliver Waidmann, Georgios Grammatikos, University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
Author contributions: Ferstl PG was in charge of medical care of the patient, compiled the relevant patient data, wrote the manuscript, and conducted literature research; Reinheimer C and Jozsa K conducted literature research and took part in writing the manuscript on behalf of the microbiological topics; Zeuzem S, Kempf VAJ, and Waidmann O were involved in the critical review of the manuscript; Grammatikos G supervised patient care during hospital admission, compiled most of the relevant patient data, and was responsible for critical review of the manuscript.
Institutional review board statement: Since medical treatment was conducted according to highest clinical standards, the present case report is not of experimental character and does not require an ethical committee statement.
Informed consent statement: Patient data and dates of treatment were anonymized prior to writing the case report. The patient provided informed written consent prior to report submission.
Conflict-of-interest statement: The authors declare no conflicts of interest whatsoever.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Philip G Ferstl, Department for Internal Medicine I/Gastroenterology and Hepatology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany. philip.ferstl@kgu.de
Telephone: +49-69-63013767
Received: August 26, 2016 Peer-review started: August 28, 2016 First decision: September 21, 2016 Revised: October 13, 2016 Accepted: October 31, 2016 Article in press: October 31, 2016 Published online: March 21, 2017 Processing time: 204 Days and 21.5 Hours
Abstract
Massive global spread of multidrug-resistant (MDR) Salmonella spp. 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, MDR Salmonella spp. 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 MDR Salmonella enterica serotype 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 of Salmonella enterica serotype Choleraesuis in Europe expressing such a multidrug resistance pattern. ESBL resistance of Salmonella enterica spp. should be considered in patients with obstructive biliary tract pathology and travel history in endemic countries.
Core tip: We report a case of aggressive infection with a multidrug resistant strain of Salmonella choleraesuis in a patient with primary sclerosing cholangitis. Successful treatment involved repetitive ultrasound and endoscopic intervention, as well as multiple adjustments of the antibiotic regimen. This is the first case report addressing multidrug-resistant salmonellosis in patients with predisposing biliary disease in Europe. It illustrates how close interdisciplinary cooperation between clinicians and microbiologists is warranted in an era of emerging antibiotic resistance.
