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Antimicrobial Agents and Chemotherapy, February 2003, p. 563-567, Vol. 47, No. 2
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.2.563-567.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

In Vivo Acquisition of Ceftriaxone Resistance in Salmonella enterica Serotype Anatum

Lin-Hui Su,1 Cheng-Hsun Chiu,2* Chishih Chu,3 Mei-Hui Wang,2 Ju-Hsin Chia,1 and Tsu-Lan Wu1

Department of Clinical Pathology, Chang Gung Memorial Hospital,1 Department of Pediatrics, Chang Gung Children's Hospital,2 Department of Microbiology and Immunology, Chang Gung University College of Medicine, Taoyuan, Taiwan3

Received 6 August 2002/ Returned for modification 17 September 2002/ Accepted 12 November 2002

The emergence of resistance to antimicrobial agents within the salmonellas is a worldwide and severe problem. A case of treatment failure due to the emergence of resistance to ceftriaxone in Salmonella enterica serotype Anatum was studied. S. enterica serotype Anatum and Escherichia coli, both of which are susceptible to ceftriaxone, were initially isolated from a diabetic patient hospitalized for the treatment of wound and urinary tract infections. Resistant S. enterica serotype Anatum and E. coli strains were isolated concomitantly 2 weeks after the initiation of ceftriaxone therapy. The patient eventually died of a sepsis caused by the ceftriaxone-resistant salmonella. PCR, nucleotide sequence analysis, and DNA-DNA hybridization identified a blaCTX-M-3 gene located on a 95.1-kb plasmid from the ceftriaxone-resistant isolates of S. enterica serotype Anatum and E. coli. The plasmid was proved to be conjugative. Molecular fingerprinting showed that the susceptible and resistant strains were genetically indistinguishable. The emergence of resistance to ceftriaxone in S. enterica serotype Anatum was due to the in vivo acquisition of a plasmid containing the blaCTX-M-3 gene and was the cause for treatment failure in this patient.

* Corresponding author. Mailing address: Department of Pediatrics, Chang Gung Children's Hospital, 5 Fu-Hsin St., Kweishan 333, Taoyuan, Taiwan. Phone: 886 3 3281200. Fax: 886 3 3288957. E-mail: chchiu{at}adm.cgmh.org.tw.

Antimicrobial Agents and Chemotherapy, February 2003, p. 563-567, Vol. 47, No. 2
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.2.563-567.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



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