Development of Carbapenem Resistance While on Antibiotic Therapy in a Patient with Melioidosis

We present a case of a 46-year-old male with disseminated melioidosis. He initially presented with primary bacteremia but eventually developed a recrudescent infection characterized by meningo-rhombencephalitis, as well as pulmonary and splenic abscesses. This was attributed to the emergence of carbapenem resistance, which developed while he was receiving parenteral antibiotic therapy. The patient eventually improved after switching his antibiotics to a combination of ceftazidime and trimethoprim-sulfamethoxazole. The development of carbapenem resistance in Burkholderia pseudomallei during therapy is rare but may be attributed to mutations resulting in the overexpression of efflux pumps. Combination therapy may play a role in such cases by limiting the emergence of antibiotic resistance.