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CTX-M15 type ESBL producing Salmonella from a paediatric patient in Chennai, India

The Indian Journal of Medical Research
Medknow Publications
Publication Date
  • Correspondence
  • Medicine


Sir, Resistance to 3rd generation cephalosporins in Salmonella has been attributed to the production of extended spectrum β-lactamases (ESBLs), but AmpC and KPC or metallo β-lactamase (MBL) mediated resistance have also been reported1. ESBLs reported in Salmonella spp. are the derivatives of TEM, SHV, CTX-M and PER type β-lactamase families1. We isolated Salmonella enterica ser. Typhimurium (B9903) from the blood culture of a 6-month old baby admitted to a paediatric hospital in Chennai in October, 2009. The patient was febrile, lethargic and refused intake. The baby was diagnosed with haemophagocytic syndrome with NK cell deficiency, dengue hemorrhagic fever grade IV, sepsis, steroid induced hypertension. The baby responded to ciprofloxacin and co-trimoxazole along with intravenous immunoglobin and steroids. The child was well at the time of discharge after 17 days in hospital. There was no history of travel or any animal contact. Species identification and antibiotic susceptibility were performed by automated system (VITEK-2, France). The isolate was further confirmed by serotyping using specific antiserum. Antigenic structure of the isolate was identified as O4, 12: H phase 1 – i: phase 2 – 1, 2 at National Salmonella & Escherichia Centre, Central Research Institute, Kasauli, India. The antibiotic susceptibility testing was interpreted according to CLSI guidelines2. The isolate was resistant to ampicillin, cefepime, ceftriaxone and ceftazidime but susceptible to piperacillin/tazobactam, ciprofloxacin, co-trimoxazole, and tetracycline. The ESBL phenotype was determined by combined disc synergy test 2 and further confirmed by using E-strip (AB bioMerieux, Solna, Sweden) with cefotaxime and clavulanic acid. The strain was identified as belonging to Salmonella phage type group E. The phage typing was carried out at National Salmonella Phage Typing Centre at Lady Hardinge Medical College, New Delhi. PCR-assays for the genes encoding β-lactamases3 showed that S. Typhimurium B9903 was found to ca

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