Published online Mar 21, 2017. doi: 10.3748/wjg.v23.i11.2086
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
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.