Ceftazidime-resistance in pediatric melioidosis : A case report and literature review

Tonnii Sia, Loong Loong and Charles, Lai Dekun and Kamilah, Manan and Khiu, Fu Lung and Siti Zakiyyah, Bakhtiar and Chor, Yek Kee and Chien, Su Lin and Tan, Lee See and Ooi, Mong How and Anand, Mohan (2025) Ceftazidime-resistance in pediatric melioidosis : A case report and literature review. IDCases, 39. pp. 1-9. ISSN 2214-2509

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Abstract

We report a first case of ceftazidime-resistant pediatric melioidosis involving a previously healthy seven-year-old boy who presented with right lobar pneumonia complicated with a 5-cm lung abscess. Ceftazidime was initiated on Day-6 of admission when Burkholderia pseudomallei (ceftazidime-susceptible, minimum inhibitory concentration [MIC] 1.0 mcg/mL) was isolated from blood. Despite ceftazidime therapy at the recommended dosage, he developed fulminant septic shock and respiratory failure on Day-18 of hospitalization, requiring invasive ventilation, hemodynamic support, and continuous renal replacement therapy. His antibiotic was empirically escalated to meropenem; ceftazidime-resistant B. pseudomallei (MIC 32 mcg/mL) was subsequently isolated from blood and endotracheal secretions. He improved after two weeks of intensive care and was discharged well after two months of hospitalization. Our literature review on ceftazidime-resistant B. pseudomallei infection indicates that acquired resistance is a rare but potentially lethal treatment-related complication. All melioidosis patients should be carefully monitored during treatment with ceftazidime (or other β-lactams) for the development of antimicrobial resistance.

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