FC 0104-WEEK ANTIBIOTIC THERAPY PREVENTS RECURRENT RENAL CYST INFECTIONS IN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE

Abstract

\n \n \n Renal cyst infection (CI) is a major complication of autosomal dominant polycystic kidney disease (ADPKD), associated with frequent hospitalization, worsening of kidney function and significant mortality. Data regarding treatment are scarce and recommendations only expert-based, with low level of evidence. Prolonged treatment duration and use of lipid-soluble antibiotics may increase antibiotic concentration in infected kidney cysts. However, benefits of this strategy have never been investigated in clinical practice.\n \n \n \n We undertook a monocentric retrospective study of CI in ADPKD patients from 2000 to 2018. CI were classified as “definite” (microbiologically proven), “probable” (clinical/biological and radiological signs) or possible (clinical/biological signs). Determinants of treatment failure and recurrences were studied.\n \n \n \n 139 CI (11 “definite”, 74 “probable”, 54 “possible”) were compiled among 90 patients. Median age was 53 years. 28/90 (31%) were kidney transplant recipients. Escherichia coli was identified in 89/106 (84%) episodes. Treatment failure was reported in 22/139 (16%), and found associated with cyst diameter >5cm (80% vs 36%, P<0.01), cyst wall thickening (53% vs 12%, P<0.001), cyst septations (18% vs 1%, P<0.01), intracystic gas (18% vs 1%, P<0.01), kidney abscess (35% vs 1%, P<0.001), higher C-reactive protein level (210 [140-358] vs 145 [99-213] mg/L, P<0.01) or documentation of Staphylococcus aureus and lugdunensis (P<0.001). Recurrence was reported in 20/139 (14%) cases within 1-year follow-up. Recurrence rate was lower in patients treated with lipid soluble antibiotics than with non-lipid soluble antibiotics (HR=0.34 [0.12-0.97], p=0.045). Most importantly, cases with definite and probable CI experienced significantly fewer recurrences when treated with longer treatment duration: 81% for treatment <21 days, 47% for 21-27 days, but only 2% for ≥28 days (p<0.0001).\n \n \n \n Treatment of kidney CI should last ≥28 days and include when possible lipid soluble antibiotics.\n