Community-Onset Pyomyositis Caused by a Salmonella enterica Serovar Enteritidis Sequence Type 11 Strain Producing CTX-M-15 Extended-Spectrum β-Lactamase

Abstract

cWe report a case of community-onset pyomyositis due to Salmonella enterica serovar Enteritidis in South Korea. The isolated strain was resistant to extended-spectrum cephalosporins and harbored sequence type 11 coproducing CTX-M-15 extendedspectrum ␤-lactamase (ESBL). Physicians should be alert for early diagnosis and appropriate treatment since ESBL-producing nontyphoidal Salmonella infections are difficult to treat without initiation of appropriate empirical antibiotics. CASE REPORTA 73-year-old woman presented to our emergency room from an outside institution with a 2-week history of right inguinal pain and fever. She had been diagnosed with diabetes mellitus (DM) 10 years prior. On admission, her initial vital signs showed a blood pressure range of 130/80 mm of mercury (mm Hg), a heart rate of 88 beats per min, a respiratory rate of 16 breaths per min, and a temperature of 38.3°C. Physical examination revealed swelling, warmth, and tenderness of the right inguinal area. There was no evidence of trauma. Her laboratory results were as follows: white blood cell count, 22 ϫ 10 9 /liter (96% neutrophils); hemoglobin, 9.7 g/dl; platelet count, 548 ϫ 10 9 /liter; alkaline phosphatase, 319 IU/liter; gamma-glutamyl transpeptidase, 115 IU/liter; total bilirubin, 0.74 mg/dl; total protein, 5.4 g/dl; albumin, 2.5 g/dl; blood urea nitrogen, 8 mg/dl; creatinine, 0.73 mg/dl; glycated hemoglobin (HbA1c), 7.4%; lactate dehydrogenase, 725 IU/liter; and C-reactive protein, 207.52 mg/liter. Magnetic resonance imaging (MRI) was performed, and the results revealed osteomyelitis and necrosis of the right pubic bone and pyomyositis of the adductor and pectineus muscles (Fig. 1). On the day of admission, the patient underwent debridement of the infected tissue. During the operation, purulent material around the right rectus abdominis and adductor muscles and a severe osteolytic lesion in the right pubic bone were removed. Intravenous ceftriaxone and metronidazole were administered empirically.A group D nontyphoidal Salmonella isolate was identified in the peripheral blood drawn at the outside institution prior to admission to our hospital. The specimen collected during debridement in our operating room also revealed the presence of the same bacterial species. Regarding the past medical history of the patient, she did not have a history of trauma and had not recently traveled abroad. She had not been treated with antimicrobial agents or hospitalized within the last 3 months. She did not report any symptoms suggestive of food poisoning such as nausea, vomiting, diarrhea, or abdominal pain. She did not have a history of contact with animals and had not eaten eggs, poultry, or meat within 2 weeks of admission.On hospital day 4, her antibiotic regimen was changed to meropenem in accordance with the antimicrobial susceptibility results. Intravenous meropenem (2.0 g every 8 h) was administered to the patient for 10 weeks. During her course of antibiotic therapy, four additional incisions and debridements were conducted, after which she im...

A common Salmonella Enteritidis sequence type from poultry and human gastroenteritis in Ibagué, Colombia

“…In addition, ST11 was also reported in chicken meat (n=76) in Iran (45) and beef meat in Morocco (46) and it is the common ST harboring in the genome extended-spectrum β-lactamases (ESBL) such as CTX-M-14 and CTX-M15 that have been isolated from stool and blood samples of people in Korea (47). Salmonella Enteritidis ST11 also caused pyomyositis in humans (48) and omphalitis in chicks (49). Consequently, the data indicate that S. Enteritidis ST11 is the most common genotype circulating in poultry and causing non-typhoidal Salmonella in humans worldwide.…”

Extraintestinal Salmonellosis in the Immunocompromised: An Unusual Case of Pyomyositis

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