Persistent Multidrug-Resistant Salmonella enterica Serovar Paratyphi A Bacteremia in a Preterm Neonate: A Case Report

Neonatal sepsis caused by Salmonella enterica serovar Paratyphi A is rare and may present with nonspecific clinical features. Multidrug-resistant strains pose substantial diagnostic and therapeutic challenges, particularly in resource-limited settings.

We report a preterm neonate born at 33 weeks of gestation with a birth weight of 1800 g who initially presented with respiratory distress and was managed as transient tachypnea of the newborn. The infant subsequently developed persistent fever, feeding intolerance, abdominal distension, leukopenia, severe thrombocytopenia, and elevated inflammatory markers despite initially negative blood cultures. A blood culture obtained on Day 20 of life grew multidrug-resistant S. Paratyphi A, resistant to ceftriaxone, ciprofloxacin, pefloxacin, and trimethoprim-sulfamethoxazole, with intermediate susceptibility to amikacin. The infant required blood-product support and prolonged antimicrobial therapy. A 21-day course of empiric cefoperazone/sulbactam plus levofloxacin was administered with close monitoring and was temporally associated with clinical improvement and microbiological clearance. Blood cultures obtained on Days 45 and 50 were negative. No maternal or apparent healthcare-associated source was identified.

Persistent multidrug-resistant S. Paratyphi A bacteremia should be considered in neonates with refractory sepsis despite initially negative blood cultures. Repeated cultures, reassessment of antimicrobial susceptibility, and cautious individualized treatment are essential when laboratory capacity and therapeutic options are limited. The effectiveness of empiric salvage therapy cannot be established without direct susceptibility data and stronger supporting evidence.