title: Cyst infection in autosomal dominant polycystic kidney disease: causative microorganisms and susceptibility to lipid-soluble antibiotics.
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.
authors: Department of Nephrology, Toranomon Hospital Kajigaya, 1-3-1 Kajigaya, Takatsu-ku, Kawasaki, Kanagawa, 213-8587, Japan, suwabe@toranomon.gr.jp.
authors: T
authors: T
authors: Suwabe
authors: H
authors: H
authors: Araoka
authors: Y
authors: Y
authors: Ubara
authors: K
authors: K
authors: Kikuchi
authors: R
authors: R
authors: Hazue
authors: K
authors: K
authors: Mise
authors: S
authors: S
authors: Hamanoue
authors: T
authors: T
authors: Ueno
authors: K
authors: K
authors: Sumida
authors: N
authors: N
authors: Hayami
authors: J
authors: J
authors: Hoshino
authors: A
authors: A
authors: Imafuku
authors: M
authors: M
authors: Kawada
authors: R
authors: R
authors: Hiramatsu
authors: E
authors: E
authors: Hasegawa
authors: N
authors: N
authors: Sawa
authors: K
authors: K
authors: Takaichi
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006801:Humans; D007239:Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D007677:Kidney Function Tests; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications* / Q000503:physiopathology / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents