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

An 80-year-old man was diagnosed to have pneumonia and advanced chronic kidney disease. He presented with anuria and hemodialysis, by temporary femoral catheter, was initiated. He was empirically treated with impanel /cilastatin 500 mg / 24 h after hemodialysis. After 10 days of antibiotic intake, he developed severe diarrhea. Diagnosis of Clostridium difficult (CD)-associated diarrhea was confirmed by detection of the toxins A and B in his stool. Impanel therapy was discontinued; Vancomycin 500 mg orally every 6 h and 1000 mg per rectum every day was added. After two weeks of this treatment, the patient reported complete resolution of the diarrhea and stool samples were negative for Clostridium toxin. In this case, the most possible cause of CD colitis was considered to be impanel because of the temporal relationship between exposure to the drug and onset of symptoms.