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Imipenem-induced Clostridium difficile diarrhea in a patient with chronic renal failure

R Enriquez1, J Borrás-Blasco, A E Sirvent

  • 1Hospital General Universitario de Elche, Alicante, Spain.

Saudi Journal of Kidney Diseases and Transplantation : an Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia
|May 14, 2011
PubMed

Insights

A patient with pneumonia and kidney disease developed severe diarrhea after imipenem treatment. This was diagnosed as Clostridium difficile colitis, resolving after switching to vancomycin, suggesting imipenem as the likely cause.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Pharmacology

Background:

  • An 80-year-old male patient with pneumonia and advanced chronic kidney disease (CKD) presented with anuria.
  • Hemodialysis was initiated via a temporary femoral catheter.

Observation:

  • The patient received empirical treatment with imipenem/cilastatin after hemodialysis.
  • Within 10 days, severe diarrhea developed.
  • Stool analysis confirmed Clostridium difficile (CD)-associated diarrhea by detecting toxins A and B.

Findings:

  • Imipenem therapy was discontinued.
  • Treatment was switched to oral vancomycin and rectal vancomycin.
  • Diarrhea resolved completely within two weeks, with negative stool samples for Clostridium toxin.

Implications:

  • This case highlights a potential link between imipenem use and the development of Clostridium difficile colitis.
  • The temporal association suggests imipenem as the most probable causative agent.
  • This underscores the importance of considering antibiotic-induced colitis in patients with risk factors, especially those on broad-spectrum agents.

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