In this study, we report an outbreak of Salmonella enterica serotype Livingstone resistant to extendedspectrum cephalosporins that occurred in a neonatal ward of the maternity department of Farhat Hached Hospital, Sousse, Tunisia, in 2002. A total of 16 isolates were recovered from 16 babies hospitalized in the ward during the period 1 to 16 July. All these babies developed diarrhea, and three of them developed septicemia. All the isolates demonstrated resistance to ceftriaxone and ceftazidime due to the production of an extendedspectrum -lactamase (ESBL). The isolates were also resistant to aminoglycosides (kanamycin, tobramycin, netilmicin, gentamicin, and amikacin) and sulfamethoxazole-trimethoprim. DNA profiles were determined by pulsed-field gel electrophoresis using the XbaI and SpeI endonucleases and by ribotyping with PstI digestion. They yielded the same patterns, showing that the outbreak was caused by a single clone. The ESBL was identified as CTX-M-27 by sequencing of PCR products and by isoelectric focusing. The ESBL resistance was transferred by a 40-kb conjugative plasmid. The mobile insertion sequence ISEcp1 was found to be located upstream of bla CTX-M-27 in the same position as that known for a bla CTX-M-14 sequence. A new gene named dfrA21, encoding resistance to trimethoprim and carried by a 90-kb plasmid, was characterized. The dfrA21 gene was inserted as a single resistance cassette in a class I integron. The babies were treated with colistin, and all except two recovered. The outbreak came to an end when appropriate actions were taken: patient isolation, hand washing, and disinfection of the ward.Salmonellosis in humans is usually a self-limited gastroenteritis that does not warrant antimicrobial therapy. However, these infections can occasionally lead to life-threatening systemic infections that require effective chemotherapy. With the emergence of ampicillin-resistant Salmonella enterica serotype Typhimurium DT104 isolates, extended-spectrum cephalosporins (ESC) are currently the agents of choice for such chemotherapy, especially for children, for whom the use of fluroquinolones is not yet approved. The selective pressure created by the use of ESC has been described as one of the most important factors in the appearance of extended-spectrum