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Ceftriaxone treatment of multidrug-resistant Salmonella osteomyelitis
Abstract:
Empiric treatment of serious Salmonella infections has been complicated by the emergence of strains resistant to multiple antimicrobial agents, including ampicillin, chloramphenicol, and trimethoprim/sulfamethoxazole. Recent reports suggest that the third-generation cephalosporins may be effective therapy for Salmonella infections. This report describes a case of antibiotic-resistant Salmonella heidelberg prosthetic hip infection successfully treated with prosthesis removal and once-daily ceftriaxone. Tube dilution sensitivity testing of the organism demonstrated minimal inhibitory and minimal bactericidal concentrations of 0.12 microgram/ml. Serum bactericidal activity, 30 minutes after infusion, was inhibitory and bactericidal at 1:512. It is concluded that the favorable preliminary results reported in the literature and the outcome in this patient suggest that the third-generation cephalosporins may be effective therapy for Salmonella infections and should undergo clinical trials.
Insights
Antibiotic-resistant Salmonella infections pose a challenge. This case highlights successful treatment of a Salmonella Heidelberg prosthetic hip infection using prosthesis removal and ceftriaxone, suggesting third-generation cephalosporins show promise.
Area of Science:
- Infectious Diseases
- Microbiology
- Orthopedic Surgery
Background:
- Emergence of multidrug-resistant Salmonella strains complicates empiric treatment.
- Third-generation cephalosporins are being investigated as potential therapies for Salmonella infections.
Observation:
- A case of antibiotic-resistant Salmonella Heidelberg prosthetic hip infection is presented.
- Treatment involved surgical removal of the prosthesis and administration of once-daily ceftriaxone.
Findings:
- Antimicrobial sensitivity testing showed ceftriaxone was effective with low minimal inhibitory and bactericidal concentrations (0.12 µg/ml).
- Serum bactericidal activity against the isolate was high (1:512 at 30 minutes post-infusion).
Implications:
- This case suggests third-generation cephalosporins, like ceftriaxone, may be effective for treating serious Salmonella infections.
- Further clinical trials are warranted to confirm the efficacy of third-generation cephalosporins in Salmonella infections.