FC 0104-WEEK ANTIBIOTIC THERAPY PREVENTS RECURRENT RENAL CYST INFECTIONS IN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE. (29th May 2021)

• Record Type: Journal Article
• Authors: Dang, Julien; Knebelmann, Bertrand; Charlier, Caroline
• Is Part Of: Nephrology dialysis transplantation. Volume 36(2021)Supplement 1
• Publication Date: 2021-05-29
• Subjects: Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfab125.003
• Languages: English
• ISSNs: 0931-0509

Abstract

Abstract: Background and Aims: 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. Method: 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. Results: 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). Conclusion: Treatment of kidney CI should last ≥28 days and include when possible lipid soluble antibiotics.