Antimicrobial Resistance in Chronic Diarrhea: A Case Report of Cefazolin-Resistant Enteric Infection
Case Report
DOI:
https://doi.org/10.55175/cdk.v53i10.1944Keywords:
Antimicrobial resistance, case report, cefazolin resistance, chronic diarrhea, enteric infectionAbstract
Introduction: Antimicrobial resistance is an emerging global health challenge that may lead to treatment failure and prolonged illness. Although cefazolin resistance is relatively uncommon, it can complicate infectious disease management, including chronic diarrhea. Case: A 7-month-old girl presented with fever and chronic mucoid diarrhea. Despite treatment with multiple antibiotics, including cefazolin, metronidazole, and vancomycin, her symptoms worsened, with diarrhea increasing to seven episodes daily, accompanied by severe anemia and malnutrition. Antibiotic susceptibility testing revealed isolated cefazolin resistance (MIC = 64 μg/mL). After susceptibility-guided treatment with intravenous ciprofloxacin and supportive care, the patient improved significantly and was discharged after 10 days. Discussion: This case highlights the importance of considering antimicrobial resistance in children with persistent diarrhea who fail to respond to empirical antibiotic therapy. Cefazolin resistance likely contributed to treatment failure and clinical deterioration. Early microbiological investigation and susceptibility-guided therapy were essential to achieve clinical recovery and prevent further complications. Conclusion: Clinicians should consider cefazolin-resistant enteric infection in cases of chronic diarrhea with poor response to empirical treatment. Prompt culture and antibiotic susceptibility testing are crucial to guide appropriate antimicrobial therapy and improve patient outcomes.
Downloads
References
Ma H, Zhang L, Wang L, Yang Z, Liu J, Sun H, et al. Antibiotic Mechanisms and Resistance: Molecular Insights and Therapeutic Strategies. Antibiotics. 2026 Mar 29;15(4):351. doi:10.3390/antibiotics15040351
Elshobary ME, Badawy NK, Ashraf Y, Zatioun AA, Masriya HH, Ammar MM, et al. Combating Antibiotic Resistance: Mechanisms, Multidrug-Resistant Pathogens, and Novel Therapeutic Approaches: An Updated Review. Pharmaceuticals. 2025 Mar 12;18(3):402. doi:10.3390/ph18030402
Siahaan S, Herman MJ, Fitri N. Antimicrobial Resistance Situation in Indonesia: A Challenge of Multisector and Global Coordination. J Trop Med. 2022 Feb 7;2022:1–10. doi:10.1155/2022/2783300
Sora VM, Wallet C, Meroni G, Loustau T, Rohr O, Zecconi A, et al. Antimicrobial Resistance: How Can We Overcome the Problem? Antibiotics. 2026 Jan 14;15(1):82. doi:10.3390/antibiotics15010082
Bostanghadiri N, Narimisa N, Kouhzad M, Nourollahi D, Shafiezadeh A, Navidifar T. Global Antimicrobial Resistance Trends in Group B Streptococcus Isolates From Pregnant Women: Systematic Review and Meta-Analysis. Microbiologyopen. 2025 Dec 30;14(6). doi:10.1002/mbo3.70087
Lambert K V, Demkowicz R, Murray A, Howard C, Slain D. Ceftriaxone Versus Cefazolin Susceptibility as a Surrogate Marker for Cefpodoxime Susceptibility in Enterobacterales. Open Forum Infect Dis. 2024 Jun 28;11(7). doi:10.1093/ofid/ofae377
Lo CKF, Sritharan A, Zhang J, Li N, Zhang C, Wang F, et al. Clinical significance of cefazolin inoculum effect in serious MSSA infections: a systematic review. JAC Antimicrob Resist. 2024 May 6;6(3). doi:10.1093/jacamr/dlae069
Leroy AG, Crenn V, Le Turnier P, Pineau S, Grossi O, Bémer P. Cefazolin resistance among gram-negative bacilli isolated from prosthetic joint infections: a French observational study. Clinical Microbiology and Infection. 2023 Feb;29(2):263–4. doi:10.1016/j.cmi.2022.10.029
Naghavi M, Vollset SE, Ikuta KS, Swetschinski LR, Gray AP, Wool EE, et al. Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050. The Lancet. 2024 Sep;404(10459):1199–226. doi:10.1016/S0140-6736(24)01867-1
Salam MdA, Al-Amin MdY, Salam MT, Pawar JS, Akhter N, Rabaan AA, et al. Antimicrobial Resistance: A Growing Serious Threat for Global Public Health. Healthcare. 2023 Jul 5;11(13):1946. doi:10.3390/healthcare11131946
Ho CS, Wong CTH, Aung TT, Lakshminarayanan R, Mehta JS, Rauz S, et al. Antimicrobial resistance: a concise update. Lancet Microbe. 2025 Jan;6(1):100947. doi:10.1016/j.lanmic.2024.07.010
Neupane R, Bhathena M, Das G, Long E, Beard J, Solomon H, et al. Antibiotic resistance trends for common bacterial aetiologies of childhood diarrhoea in low- and middle-income countries: A systematic review. J Glob Health. 2023 Jul 21;13:04060. doi:10.7189/jogh.13.04060
Halawa EM, Fadel M, Al-Rabia MW, Behairy A, Nouh NA, Abdo M, et al. Antibiotic action and resistance: updated review of mechanisms, spread, influencing factors, and alternative approaches for combating resistance. Front Pharmacol. 2024 Jan 12;14. doi:10.3389/fphar.2023.1305294
Chinemerem Nwobodo D, Ugwu MC, Oliseloke Anie C, Al-Ouqaili MTS, Chinedu Ikem J, Victor Chigozie U, et al. Antibiotic resistance: The challenges and some emerging strategies for tackling a global menace. J Clin Lab Anal. 2022 Sep 10;36(9). doi:10.1002/jcla.24655
Urban-Chmiel R, Marek A, Stępień-Pyśniak D, Wieczorek K, Dec M, Nowaczek A, et al. Antibiotic Resistance in Bacteria—A Review. Antibiotics. 2022 Aug 9;11(8):1079. doi:10.3390/antibiotics11081079
Nocua-Báez LC, Reyes P, Cortes JA. Effect of Inadequate Treatment in Adult Patients with Community-Acquired Acute Pyelonephritis Due to Enterobacterales Under Empirical Management with Cefazolin. Antibiotics. 2025 Feb 14;14(2):197. doi:10.3390/antibiotics14020197
Oliveira M, Antunes W, Mota S, Madureira-Carvalho Á, Dinis-Oliveira RJ, Dias da Silva D. An Overview of the Recent Advances in Antimicrobial Resistance. Microorganisms. 2024 Sep 21;12(9):1920. doi:10.3390/microorganisms12091920
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Gembong Satria Mahardhika, Aulia Nurul Izzati, Nimas Adiani Sekar Laranti, Fatmanur Hurulhanifa, Hanifa Nur Shabrina, Qodri Santosa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
