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.