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Cyst infection in autosomal dominant polycystic kidney disease: causative microorganisms and susceptibility to lipid-soluble antibiotics

European Journal of Clinical Microbiology & Infectious Diseases volume 34, pages 1369–1379 (2015)Cite this article

Abstract

Cyst infection is a frequent and serious complication of autosomal dominant polycystic kidney disease (ADPKD). Lipid-soluble antibiotics like fluoroquinolones show good penetration into cysts and are recommended for cyst infection, but causative microorganisms are often resistant to these agents. This study investigated the profile of the microorganisms causing cyst infection in ADPKD, their susceptibility to lipid-soluble antibiotics, and clinical outcomes. This retrospective study reviewed all ADPKD patients admitted to Toranomon Hospital with a diagnosis of cyst infection from January 2004 to March 2014. All patients who underwent cyst drainage and had positive cyst fluid cultures were enrolled. Patients with positive blood cultures who satisfied our criteria for cyst infection or probable infection were also enrolled. There were 99 episodes with positive cyst fluid cultures and 93 episodes with positive blood cultures. The majority of patients were on dialysis. The death rate was high when infection was caused by multiple microorganisms or when there were multiple infected cysts. Gram-negative bacteria accounted for 74–79 % of the isolates in all groups, except for patients with positive hepatic cyst fluid cultures. The susceptibility of Escherichia coli to fluoroquinolones was very low in patients with hepatic cyst infection, especially those with frequent episodes and those with hepatomegaly. Fungi were detected in two episodes. Fluoroquinolone-resistant microorganisms showed a high prevalence in cyst infection. It is important to identify causative microorganisms to avoid the overuse of fluoroquinolones and to improve the outcome of cyst infection in ADPKD.

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Acknowledgments

This study was supported in part by a Grant-in-Aid for Progressive Renal Disease Research from the Ministry of Health, Labour and Welfare of Japan and by the Okinaka Memorial Institute for Medical Research, Toranomon Hospital. The language content of this manuscript was checked by a native English-speaking medical editor from Yamada Translation Bureau, Inc. (Tokyo, Japan).

Contribution to assessment of imaging findings

We wish to thank Satoshi Saitoh, MD (Department of Hepatology, Toranomon Hospital) and Itsuko Okuda, MD (Department of Diagnostic Radiology, International University of Health and Welfare, Mita Hospital).

Conflict of interest

The authors declare that they have no conflict of interest.

Compliance with ethical standards

This retrospective observational study was reviewed and approved by the ethics committee of Toranomon Hospital. This study’s protocols conformed to provisions of the Declaration of Helsinki. For this type of study, formal consent is not required.

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Affiliations

  1. Department of Nephrology, Toranomon Hospital Kajigaya, 1-3-1 Kajigaya, Takatsu-ku, Kawasaki, Kanagawa, 213-8587, Japan

    T. Suwabe, Y. Ubara, K. Kikuchi, R. Hazue, K. Mise, S. Hamanoue, T. Ueno, K. Sumida, N. Hayami, J. Hoshino & K. Takaichi

  2. Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan

    H. Araoka

  3. Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan

    Y. Ubara & K. Takaichi

  4. Department of Nephrology, Toranomon Hospital , Tokyo, Japan

    A. Imafuku, M. Kawada, R. Hiramatsu, E. Hasegawa, N. Sawa & K. Takaichi

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  1. T. Suwabe
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  2. H. Araoka
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  3. Y. Ubara
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  4. K. Kikuchi
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  5. R. Hazue
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  6. K. Mise
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  7. S. Hamanoue
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  8. T. Ueno
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  9. K. Sumida
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  10. N. Hayami
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  11. J. Hoshino
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  12. A. Imafuku
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  13. M. Kawada
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  14. R. Hiramatsu
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  15. E. Hasegawa
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  16. N. Sawa
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  17. K. Takaichi
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Corresponding author

Correspondence to T. Suwabe.

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Suwabe, T., Araoka, H., Ubara, Y. et al. Cyst infection in autosomal dominant polycystic kidney disease: causative microorganisms and susceptibility to lipid-soluble antibiotics. Eur J Clin Microbiol Infect Dis 34, 1369–1379 (2015). https://doi.org/10.1007/s10096-015-2361-6

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  • DOI: https://doi.org/10.1007/s10096-015-2361-6

Keywords

  • Positive Blood Culture
  • Autosomal Dominant Polycystic Kidney Disease
  • Cyst Fluid
  • Hepatic Cyst
  • Supplementary Appendix