Ceftriaxone-resistant multidrug-resistant Salmonella Typhi sepsis in pregnancy

A primigravida at 26 weeks' gestation visiting from Pakistan presented with fever, abdominal pain and hypotension suggestive of sepsis and required admission to the intensive care unit. Blood culture grew a multidrug-resistant (MDR) Salmonella enterica serovar Typhi isolate that was resistant to cephalosporins but susceptible to carbapenems. Intravenous meropenem was commenced, resulting in a rapid clinical improvement within 48 hours. She completed a 14-day course of meropenem without maternal or fetal adverse effects, and repeat blood cultures were sterile. The remainder of her pregnancy was uncomplicated, and she delivered a healthy term infant. This case highlights the diagnostic and therapeutic challenges of MDR, cephalosporin-resistant Salmonella Typhi infection during pregnancy and supports meropenem as an effective and potentially life-saving treatment associated with favourable maternal and fetal outcomes.