We report a case of ceftriaxone (CTX) treatment failure for bacteremia caused bySalmonella entericasubsp.entericaserovar Typhimurium, due to thein vivoacquisition of ablaCTX-M-27-encoding IncFII group transmissible plasmid. The original β-lactamase-susceptible isolate ST882S was replaced by the resistant isolate ST931R during ceftriaxone treatment. After relapse, treatment was changed to ciprofloxacin and the patient recovered. Isolate ST931R could transfer resistance toE. coliat 37 °C. We used whole-genome sequencing of ST882S and ST931R, theE. colitransconjugant, and isolated plasmid DNA to unequivocally show that ST882S and ST931R had identical chromosomes, both having identical 206 single nucleotide polymorphisms (SNPs) versusS.Typhimurium 14028s. We assembled a complete circular genome for ST931R, to which ST882S reads mapped with no SNPs. ST882S and ST931R were isogenic except for the presence of 3 additional plasmids in ST931R. ST931R and theE. colitransconjugant were ceftriaxone-resistant due to the presence of a 60.5 kb IS26-flanked-blaCTX-M-27encoding IncFII plasmid. Compared to 14082s, ST931R has almost identical Gifsy-1, Gifsy-2, and ST64B prophages, lacks Gifsy-3 and instead carries a unique Fels-2 prophage related to that found in LT2. ST882S and ST931R both had a 94 kb virulence plasmid showing >99% identity with pSLT14028s, and a cryptic 3904 bp replicon; ST931R also has cryptic 93 kb IncI1 and 62 kb IncI2 group plasmids. To the best of our knowledge,in vivoacquisition of extended spectrum β-lactamase-resistance byS. Typhimurium andblaCTX-M-27genes in US isolates ofSalmonellahave not previously been reported.