{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T10:45:07Z","timestamp":1751625907489,"version":"3.41.0"},"reference-count":16,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>We present a case of a 46-year-old male with disseminated melioidosis. He initially presented with primary bacteremia but eventually developed a recrudescent infection characterized by meningo-rhombencephalitis, as well as pulmonary and splenic abscesses. This was attributed to the emergence of carbapenem resistance, which developed while he was receiving parenteral antibiotic therapy. The patient eventually improved after switching his antibiotics to a combination of ceftazidime and trimethoprim-sulfamethoxazole. The development of carbapenem resistance in <jats:italic>Burkholderia pseudomallei<\/jats:italic> during therapy is rare but may be attributed to mutations resulting in the overexpression of efflux pumps. Combination therapy may play a role in such cases by limiting the emergence of antibiotic resistance.<\/jats:p>","DOI":"10.4269\/ajtmh.24-0819","type":"journal-article","created":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T19:10:38Z","timestamp":1744139438000},"page":"1252-1255","source":"Crossref","is-referenced-by-count":1,"title":["Development of Carbapenem Resistance While on Antibiotic Therapy in a Patient with Melioidosis"],"prefix":"10.4269","volume":"112","author":[{"given":"Matthew Chung Yi","family":"Koh","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore, Singapore;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alicia","family":"Ang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Woodlands Health, Singapore, Singapore;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinghao Nicholas","family":"Ngiam","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore, Singapore;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David Michael","family":"Allen","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore, Singapore;"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brenda Sze Peng","family":"Ang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Nat Rev Dis Primers","first-page":"17107","article-title":"Melioidosis","volume":"4","author":"Wiersinga","year":"2018"},{"key":"b2","series-title":"Emerg Infect Dis","first-page":"140","article-title":"Melioidosis, Singapore, 2003\u20132014","volume":"24","author":"Pang","year":"2018"},{"key":"b3","series-title":"PLoS Negl Trop Dis","first-page":"e0007320","article-title":"Central nervous system melioidosis: A systematic review of individual participant data of case reports and case series","volume":"13","author":"Wongwandee","year":"2019"},{"key":"b4","series-title":"Trans R Soc Trop Med Hyg","first-page":"72","article-title":"Cerebral melioidosis in Singapore: A review of five cases","volume":"96","author":"Chadwick","year":"2002"},{"key":"b5","series-title":"Clin Infect Dis","first-page":"968","article-title":"Melioidosis of the central nervous system: Impact of the bimABm allele on patient presentation and outcome","volume":"78","author":"Gora","year":"2024"},{"key":"b6","series-title":"CMI Communications","first-page":"100008","article-title":"Approach to melioidosis","volume":"1","author":"Meumann","year":"2024"},{"key":"b7","series-title":"PLoS Negl Trop Dis","first-page":"e0008659","article-title":"2020 Review and revision of the 2015 Darwin melioidosis treatment guideline; Paradigm drift not shift","volume":"14","author":"Sullivan","year":"2020"},{"key":"b8","series-title":"Clin Infect Dis","first-page":"381","article-title":"Comparison of imipenem and ceftazidime as therapy for severe melioidosis","volume":"29","author":"Simpson","year":"1999"},{"key":"b9","series-title":"Antimicrob Agents Chemother","first-page":"1763","article-title":"Outcomes of patients with melioidosis treated with meropenem","volume":"48","author":"Cheng","year":"2004"},{"key":"b10","series-title":"Clin Infect Dis","first-page":"1105","article-title":"Two randomized controlled trials of ceftazidime alone versus ceftazidime in combination with trimethoprim-sulfamethoxazole for the treatment of severe melioidosis","volume":"41","author":"Chierakul","year":"2005"},{"key":"b11","series-title":"Clin Infect Dis","first-page":"521","article-title":"Addition of trimethoprim-sulfamethoxazole to ceftazidime during parenteral treatment of melioidosis is not associated with a long-term outcome benefit","volume":"45","author":"Chierakul","year":"2007"},{"key":"b12","series-title":"Antimicrob Agents Chemother","first-page":"5388","article-title":"Survey of antimicrobial resistance in clinical Burkholderia pseudomallei isolates over two decades in northeast Thailand","volume":"55","author":"Wuthiekanun","year":"2011"},{"key":"b13","series-title":"Trans R Soc Trop Med Hyg","first-page":"S101","article-title":"Melioidosis: Antibiogram of cases in Singapore 1987\u20132007","volume":"102","author":"Tan","year":"2008"},{"key":"b14","series-title":"Antimicrob Agents Chemother","first-page":"e02230-20","article-title":"Antibiotic susceptibility of clinical Burkholderia pseudomallei isolates in Northeast Thailand from 2015\u20132018 and the genomic characterization of \u03b2-lactam-resistant isolates","volume":"95","author":"Fen","year":"2021"},{"key":"b15","series-title":"Clin Infect Dis","first-page":"243","article-title":"Raising the stakes: Loss of efflux pump regulation decreases meropenem susceptibility in Burkholderia pseudomallei.","volume":"67","author":"Sarovich","year":"2018"},{"key":"b16","series-title":"Clinical Microbiology and Infection","first-page":"P736","article-title":"Burkholderia pseudomallei multi-centre study to establish EUCAST MIC and zone diameter distributions and epidemiological cut-off values","volume":"27","author":"Karatuna","year":"2021"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/112\/6\/article-p1252.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/112\/6\/article-p1252.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/112\/6\/article-p1252.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T13:05:01Z","timestamp":1749042301000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/112\/6\/article-p1252.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,4]]},"references-count":16,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.24-0819","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"type":"print","value":"0002-9637"},{"type":"electronic","value":"1476-1645"}],"subject":[],"published":{"date-parts":[[2025,6,4]]}}}