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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References
Torres VE (2001) Polycystic kidney disease autosomal-dominant and recessive forms. In: Massry SG, Glassock RJ (eds) Textbook of nephrology, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 896–904
Gardner KD Jr, Evan AP (1984) Cystic kidneys: an enigma evolves. Am J Kidney Dis 3(6):403–413
Schwab SJ, Bander SJ, Klahr S (1987) Renal infection in autosomal dominant polycystic kidney disease. Am J Med 82(4):714–718
Chapman AB, Thickman D, Gabow PA (1990) Percutaneous cyst puncture in the treatment of cyst infection in autosomal dominant polycystic kidney disease. Am J Kidney Dis 16(3):252–255
Harris PC, Torres VE (2011) Autosomal dominant polycystic kidney disease. GeneReviews® [Internet], http://www.ncbi.nlm.nih.gov/books/NBK1246/. Last Updated 8 Dec. 2011
Suwabe T, Ubara Y, Sumida K, Hayami N, Hiramatsu R, Yamanouchi M, Hasegawa E, Hoshino J, Sawa N, Saitoh S, Okuda I, Takaichi K (2012) Clinical features of cyst infection and hemorrhage in ADPKD: new diagnostic criteria. Clin Exp Nephrol 16(6):892–902
Muther RS, Bennett WM (1981) Cyst fluid antibiotic concentrations in polycystic kidney disease: differences between proximal and distal cysts. Kidney Int 20(4):519–522
Bennett WM, Elzinga L, Pulliam JP, Rashad AL, Barry JM (1985) Cyst fluid antibiotic concentrations in autosomal-dominant polycystic kidney disease. Am J Kidney Dis 6(6):400–404
Schwab S, Hinthorn D, Diederich D, Cuppage F, Grantham J (1983) pH-dependent accumulation of clindamycin in a polycystic kidney. Am J Kidney Dis 3(1):63–66
Elzinga LW, Golper TA, Rashad AL, Carr ME, Bennett WM (1987) Trimethoprim–sulfamethoxazole in cyst fluid from autosomal dominant polycystic kidneys. Kidney Int 32(6):884–888
Elzinga LW, Golper TA, Rashad AL, Carr ME, Bennett WM (1988) Ciprofloxacin activity in cyst fluid from polycystic kidneys. Antimicrob Agents Chemother 32(6):844–847
Rossi SJ, Healy DP, Savani DV, Deepe G (1993) High-dose ciprofloxacin in the treatment of a renal cyst infection. Ann Pharmacother 27(1):38–39
Hiyama L, Tang A, Miller LG (2006) Levofloxacin penetration into a renal cyst in a patient with autosomal dominant polycystic kidney disease. Am J Kidney Dis 47(1):e9–e13
Schwab SJ, Weaver ME (1986) Penetration of trimethoprim and sulfamethoxazole into cysts in a patient with autosomal-dominant polycystic kidney disease. Am J Kidney Dis 7(5):434–438
Suwabe T, Ubara Y, Higa Y, Nakanishi S, Sogawa Y, Nomura K, Nishimura H, Hoshino J, Sawa N, Katori H, Takemoto F, Nakamura M, Tomikawa S, Hara S, Takaichi K (2009) Infected hepatic and renal cysts: differential impact on outcome in autosomal dominant polycystic kidney disease. Nephron Clin Pract 112(3):c157–c163
Sallée M, Rafat C, Zahar JR, Paulmier B, Grünfeld JP, Knebelmann B, Fakhouri F (2009) Cyst infections in patients with autosomal dominant polycystic kidney disease. Clin J Am Soc Nephrol 4(7):1183–1189
Jouret F, Lhommel R, Devuyst O, Annet L, Pirson Y, Hassoun Z, Kanaan N (2012) Diagnosis of cyst infection in patients with autosomal dominant polycystic kidney disease: attributes and limitations of the current modalities. Nephrol Dial Transplant 27(10):3746–3751
Truven Health Analytics, Inc. (2014) Dosing information: dosage in renal failure. DRUGDEX®
Jouret F, Lhommel R, Beguin C, Devuyst O, Pirson Y, Hassoun Z, Kanaan N (2011) Positron-emission computed tomography in cyst infection diagnosis in patients with autosomal dominant polycystic kidney disease. Clin J Am Soc Nephrol 6(7):1644–1650
Lu PL, Liu YC, Toh HS, Lee YL, Liu YM, Ho CM, Huang CC, Liu CE, Ko WC, Wang JH, Tang HJ, Yu KW, Chen YS, Chuang YC, Xu Y, Ni Y, Chen YH, Hsueh PR (2012) Epidemiology and antimicrobial susceptibility profiles of Gram-negative bacteria causing urinary tract infections in the Asia-Pacific region: 2009–2010 results from the Study for Monitoring Antimicrobial Resistance Trends (SMART). Int J Antimicrob Agents 40(Suppl):S37–S43
Fissell RB, Fuller DS, Morgenstern H, Gillespie BW, Mendelssohn DC, Rayner HC, Robinson BM, Schatell D, Kawanishi H, Pisoni RL (2013) Hemodialysis patient preference for type of vascular access: variation and predictors across countries in the DOPPS. J Vasc Access 14(3):264–272
Ravani P, Gillespie BW, Quinn RR, MacRae J, Manns B, Mendelssohn D, Tonelli M, Hemmelgarn B, James M, Pannu N, Robinson BM, Zhang X, Pisoni R (2013) Temporal risk profile for infectious and noninfectious complications of hemodialysis access. J Am Soc Nephrol 24(10):1668–1677
Matsumoto T, Hamasuna R, Ishikawa K, Takahashi S, Yasuda M, Hayami H, Tanaka K, Kiyota H, Muratani T, Monden K, Arakawa S, Yamamoto S (2011) Nationwide survey of antibacterial activity against clinical isolates from urinary tract infections in Japan (2008). Int J Antimicrob Agents 37(3):210–218
Chapman AB, Rahbari-Oskoui FF, Bennett WM (2014) Urinary tract infection in autosomal dominant polycystic kidney disease. UpToDate®. Last Updated 3 Dec. 2014
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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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