02011nas a2200301   4500000000100000008004100001260001300042653000900055653002200064653001500086653004200101653002500143653002200168653003100190653003000221653003400251653001600285653001100301653001300312653000900325653002500334100001300359245015300372300001200525490000700537520115100544022001401695       1994                            d  c1994 Nov10aAged10aAged, 80 and over10aCilastatin10aCilastatin, Imipenem Drug Combination10aCitrobacter freundii10aDrug Combinations10aDrug Resistance, Microbial10aDrug Therapy, Combination10aEnterobacteriaceae Infections10aGentamicins10aHumans10aImipenem10aMale10aPneumonia, Bacterial1 aMatsui S00a[A case of severe pneumonia in an elderly man, caused by Citrobacter freundii suspected to have a low susceptibility to imipenem/cilastatin sodium].  a1078-820 v323 a<p>An 80-year-old blind man with lepromatous leprosy suffered from right femoral neck and humeral neck fractures on July 9, 1993. Because of fever (38.6 degrees C), difficult expectoration and diffuse bilateral perihilar infiltrates with consolidation in the left lower lung field on his chest radiograph, severe pneumonia was diagnosed. With intravenous hyperalimentation, imipenem/cilastatin (IPM/CS), ceftazidime, minocycline, gentamicin (GM), and human immunoglobulin were administrated. On July 29, hip screw-plate fixation was done. Citrobacter freundii was isolated from the sputum and its susceptibility was IPM/CS+, GM3+. Multi-drug therapy with GM and other antibiotics improved the patients' condition, but Citrobacter freundii were still detected and 43 days of medication were needed. According to a report by the Ministry of Health and Welfare in 1992, the resistance rate of IPM/CS against Citrobacter freundii is only 0.7%, and IPM/CS is more effective than beta-Lactams. This is a very rare case of severe pneumonia in an elderly patient caused by Citrobacter freundii that was suspected to have low susceptibility to IPM/CS.</p>  a0301-1542