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Volume 17, Number 1—January 2011

Dispatch

Foreign Travel and Decreased Ciprofloxacin Susceptibility in Salmonella enterica Infections

Manar Al-Mashhadani, Robert Hewson, Roberto Vivancos, Alex Keenan, Nick J. Beeching, John Wain, and Christopher M. ParryComments to Author 
Author affiliations: Author affiliations: University of Liverpool, Liverpool, UK (M. Al-Mashhadani, R. Hewson, C.M. Parry); Health Protection Agency Moorgate Point, Liverpool (R. Vivancos, A. Keenan); University of Manchester, Manchester, UK (R. Vivancos); Liverpool School of Tropical Medicine, Liverpool (N.J. Beeching); Health Protection Agency Colindale, London, UK (J. Wain)

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Table A1

Clinical features and outcomes for 11 patients with nontyphoidal Salmonella enterica bacteremia, Liverpool, UK, 2003–2009*

Patient no.
Strain no.
Serovar and PT
Resistance pattern
Ciprofloxacin
MIC, µg/mL
Age, y/ sex
Preexisting condition
Travel
Clinical signs, symptoms
Initial therapy
Outcome
1 31711 Enteritidis PT4 ACSuTTm <0.060 41/F New HIV diagnosis, CD4 count 27 x 106 cells/L No Fever, cough Ciprofloxacin Initial resolution. Subsequent TB diagnosis.
2 33284 Enteritidis PT1 Pansusceptible <0.060 53/F Cholecystectomy for stones 2 years previously No Fever, complicated pancreatitis Ciprofloxacin Empirical ceftriaxone and metronidazole added
3 33474 Enteritidis PT1 NxCpL <0.060 57/F Previous breast cancer, duodenal ulcer No Acute cholecystitis Cefuroxime/
metronidazole Empyema, gall bladder disease, pancreatitis
4 43539 Enteritidis PT21 NxCpL 0.500 66/M Aortic aneurysm Turkey Fever Ciprofloxacin Persistent fever. Ciprofloxacin dose increased and ampicillin added. No evidence of graft infection. Resolution.
5 52612 Enteritidis PT21 Pansusceptible 0.060 25/F SLE, (mycophenolate and steroid treatment) Turkey Fever Amoxicillin and clavulanic acid Antimicrobial drug changed to ciprofloxacin. Resolution.
6 52981 Enteritidis PT21 ACCro 0.060 47/F Post bone marrow allograft No Fever Tazocin and gentamicin Antimicrobial drug changed to meropenem. Resolution.
7 61246 Newport NxCpL 1.000 75/F Gall bladder carcinoma
Previous isolation of salmonellae from gall bladder, DM, steroids No Fever Ciprofloxacin Recurrent bacteremia. Antimicrobial changed to ceftriaxone. Eventual resolution.
8 62856 Virchow ASuTTmNxCpL 0.250 34/F None Kenya Fever, abdominal pain Ceftriaxone Resolution.
9 71353 Enteritidis PT6a A 0.060 42/M New HIV diagnosis, CD4 count 7 × 106 cells/L No Fever, cough Ceftriaxone,
co-trimoxazole Also Pneumocystis pneumonia. Resolution.
10 76146 Enteritidis PT1 Pansusceptible 0.060 46/M Interferon treatment for chronic HBV infection No Collapse Tazocin Antimicrobial drug changed to ciprofloxacin. Resolution.
11
72429
Enteritidis PT24
ANxCpL
1.000
34/M
HIV, CD4 count
17 × 106/L, TB treatment
Thailand
Fever, cough
Ciprofloxacin
Antimicrobial drug changed to ceftriaxone because of slow response. Resolution.
*PT, phage type; A, ampicillin; C, chloramphenicol; Su, sulfamethoxazole; T, tetracycline, Tm, trimethoprim; TB, tuberculosis; Nx, nalidixic acid; CpL, decreased ciprofloxacin susceptibility; SLE, systemic lupus erythematosus; Cro, ceftriaxone; DM, diabetes mellitus; HBV, hepatitis B virus.

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