Details

Autor(en) / Beteiligte

• Wong, Waison
• Rawahi, Hatem Al
• Patel, Samir
• Yau, Yvonne
• Eshaghi, Alireza
• Zittermann, Sandra
• Tattum, Leah
• Morris, Shaun K.

Titel

The first Canadian pediatric case of extensively drug-resistant Salmonella Typhi originating from an outbreak in Pakistan and its implication for empiric antimicrobial choices

Ist Teil von

• IDCases, 2019-01, Vol.15, p.e00492, Article e00492

Ort / Verlag

Netherlands: Elsevier Ltd

Erscheinungsjahr

2019

Link zum Volltext

Quelle

Electronic Journals Library - Freely accessible e-journals

Beschreibungen/Notizen

• •Third-generation cephalosporins are common first line agents to empirically treat typhoid fever.•An outbreak of extensively-drug resistant (XDR) typhoid has emerged in Pakistan that is resistant to ceftriaxone.•This is the first Canadian case of XDR typhoid in a child who travelled to Pakistan and was successfully treated with 2 weeks of meropenem.•Clinicians should consider adapting their empiric management of typhoid for travellers returning from XDR regions. We report on a three year-old male who contracted enteric fever during a visit to the Sindh province of Pakistan in the summer of 2018. He was diagnosed after returning to Canada and blood cultures isolated Salmonella enterica serovar Typhi which harbored extensive drug-resistance (XDR) to all first-line antibiotics including ceftriaxone. Empiric ceftriaxone was switched to meropenem and he was successfully treated with a two-week course. An outbreak of XDR typhoid is currently emerging from Pakistan and several outbreak-related cases have been identified in the U.K and U.S. Whole genome sequencing confirmed that our child was infected with the XDR outbreak-strain. Current empiric antimicrobial choices will result in treatment failure if an XDR strain is encountered, therefore clinicians must adapt their empiric approach for those returning from high risk regions. This is the first XDR typhoid case in Canada and the first pediatric case to be diagnosed and treated outside of Pakistan. Clinicians must be vigilant of future cases.