Cyst Infections in Patients with Autosomal Dominant Polycystic Kidney Disease

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Figure 1.
A 53-yr-old man with autosomal dominant polycystic kidney disease (ADPKD) and chronic kidney disease (GFR 30 ml/min per 1.73 m²) presented with fever, abdominal pain (upper left quadrant), and increased serum C-reactive protein level. A left kidney cyst infection was suspected. (A through C) A nonenhanced computed tomography (CT) scan (A) and magnetic resonance imaging (T2-weighted sequence; B) disclosed several renal cysts with variable fluid density in the absence of overt signs of cyst infection; however, a positron emission tomography (PET) scan (C) showed an area of increased FDG uptake (arrow) highly suggestive of ongoing infection in a left kidney cyst. (D) A 62-yr-old woman who had ADPKD and was undergoing hemodialysis (patient 6) was admitted for fever and abdominal pain (upper right quadrant). Blood cultures grew positive for Escherichia coli. Abdominal CT scan was inconclusive. A PET scan disclosed an ongoing infection in a liver cyst (arrow). (E) A control PET scan performed 1 mo after antibiotherapy (ciprofloxacin) showed the resolution of cyst infection (dashed arrow). Positive signal on the last frame occurs in the heart.

Table 1.

Characteristics of 36 patients who had ADPKD and experienced 41 episodes of renal and hepatic cyst infections^a

Infection (Patients/Episodes)	Male Gender (%)	Age (yr; Median)	GFR (ml/min per 1.73 m²; Median)	Patients on Dialysis (n [%])	Peripheral Blood Leukocyte Count (/mm³; Median)	CRP (mg/L; Median)	Positive Urine Culture (n [%])	Positive Blood Culture (n [%])
Definite renal cyst infection (6/6)	67	53	33	2 (33)	17,400	205	2 (33%)	1 (17)
Likely renal cyst infection (24/25)	46	44	60	4 (17)	10,700	168	14 (56%)	2 (8)
Definite liver cyst infection (2/2)	50	67	HD	2 (100)	–	–	–	1 (50)
Likely liver cyst infection (4/8)	50	67	HD	4 (100)	7900	161	–	6 (75)

↵^a ADPKD, autosomal dominant polycystic kidney disease; CRP, C-reactive protein; HD, hemodialysis.

Table 2.

Bacterial strains retrieved during 41 episodes of cyst infection in 36 patients with ADPKD

Infection (patients/episodes)	Positive Culture
Infection (patients/episodes)	Urine	Blood	Cyst Fluid
Definite renal cyst infection (6/6)	Escherichia coli (1)Staphylococcus aureus (1)	Escherichia coli(1)	Escherichia coli (1)Staphylococcus aureus (1)Streptococcus (1)Anaerobic (1)
Likely renal cyst infection (24/25)	Escherichia coli (13)Lactobacillus (1)	Escherichia coli (2)
Liver cyst infection (6/10)		Escherichia coli (5)Enterococcus faecium (2)	Citrobacter freundii (1)

Table 3.

Radiologic findings during 41 episodes of cyst infections in 36 patients with ADPKD

Infection (patients/episodes)	Radiologic Examination Performed (n [%] of Positive Radiologic Findings)
Infection (patients/episodes)	Ultrasound	CT Scan	MRI	PET Scan
Definite renal cyst infection (6/6)	3 (33)	5 (40)	1 (100)	3 (100)
Likely renal cyst infection (24/25)	10 (0)	18 (6)	1 (0)	1 (100)
Definite liver cyst infection (2/2)	0 (0)	1 (100)	1 (0)	1 (100)
Likely liver cyst infection (4/8)	5 (0)	4 (25)	2 (50)	3 (100)
Total (33/41)	18 (6)	28 (18)	5 (40)	8 (100)

Table 4.

Patient outcomes depending on the type of antibiotherapy used for cyst infections in patients with ADPKD

Antibiotherapy	Efficacy (n [%])	Need for Modification of Antibiotherapy (n [%])	Need for Cyst Drainage (n [%])
β-Lactamine alone (n = 6)	2 (33)	4 (67)
Fluoroquinolone alone (n = 12)	8 (66)	4 (33)	1 (8)
β-Lactamine + fluoroquinolone (n = 8)	6 (75)	2 (25)	3 (38)
β-Lactamine + aminoside (n = 6)	6 (100)
Fluoroquinolone + aminoside (n = 5)	4 (80)		1 (40)
Others (n = 3)	3 (100)
All (n = 41)	29 (71)	10 (24)	5 (12)

Table 5.

Published data regarding intracyst antibiotic diffusion in patients with ADPKD

Reference	No. of Patients	Cyst Location	Antibiotic	Intracystic Antibiotic Diffusion
Telenti et al. (7)	3	Liver	Ciprofloxacin	Good
				Concentration ratio cyst/serum 2.3 to 4.4
	1		Chloramphenicol	Good
				Concentration ratio cyst/serum 1.1
Bennett et al. (17)	10	Kidney	Amoxicillin	Poor on day 1/good on day 6
			Aminoside	Poor
			Clindamycin	Good
			Metronidazole	Good
			Bactrim	Good
			Vancomycin	Good
Elzinga et al. (18)	7	Kidney	Ciprofloxacin (oral)	Good
				Concentration ratio cyst/serum 2.5
Hiyama et al. (12)	1	Kidney	Ampicillin	Poor
				Concentration ratio cyst/serum <0.4
			Levofloxacin	Good
				Concentration ratio cyst/serum 0.96
Elzinga et al. (19)	8	Kidney	Trimethoprim	Good
				Concentration ratio cyst/serum >8
			Sulfamethoxazole	Poor
				Concentration ratio cyst/serum 0.1 to 0.7
Schwab et al. (20)	1	Kidney	Trimethoprim	Good
				Concentration ratio cyst/serum 1.6 to 23.0
			Sulfamethoxazole	Poor
				Concentration ratio cyst/serum 0.07 to 0.70
Schwab et al. (21)	1	Kidney	Clindamycin	Good
				Concentration ratio cyst/serum 2.4 to 8.7
			Gentamycin	Poor
				Concentration ratio cyst/serum 0.18 to 0.34