[en] [en] INTRODUCTION: Liver cyst infection is a rare and severe complication of the liver cysts associated with autosomal dominant polycystic kidney disease (ADPKD), and evidence-based data for optimal management is lacking. We conducted a multicentric retrospective study to investigate the treatment and outcomes of liver cyst infection.
METHODS: Liver cyst infection was either defined by (i) C-reactive protein levels ≥ 50 mg/l and suspicion at computed tomography (CT) scan, 18Fluorodeoxyglucose (18FDG) positron-emission tomography (PET) CT, magnetic resonance imaging (MRI); or (ii) proven by cyst puncture. We studied the determinants of treatment failure (persistent infection with requirement for antibiotic therapy change, cyst drainage, and hepatectomy), relapse (< 2 months) and recurrence (> 2 months) of liver cyst infection after antibiotics discontinuation.
RESULTS: Sixty-two patients and 112 episodes were included. At least 1 microorganism was identified in 70 of 112 episodes (63%), mainly Escherichia coli in 36 of 70of cases (51%). E coli was resistant to third generation cephalosporin, fluoroquinolone, or cotrimoxazole in 13%, 16%, and 34%, respectively. Treatment failure and relapse occurred in 30 of 112 episodes (27%). Antibiotic therapy duration ≥ 14 days was a protective factor for treatment failure or relapses (odds ratio [OR] = 0.03, 95% confidence interval [CI]: 0-0.23], P = 0.006). Recurrence occurred in 24 of 62 patients (38%), within 1 year for 15 patients (24%) after the first episode. An antibiotic therapy duration ≥ 28 days was identified as a protective factor (OR = 0.12, 95% CI: 0.02-0.65], P = 0.021). Conversely, a history of renal cyst infection significantly increased the risk of recurrence within 1 year (OR = 9.22 95% CI: 1.28-99.55], P = 0.04).
CONCLUSION: Treatment failure or relapse or recurrence of liver cyst infection both occurred in one-third of cases, and are associated with a shorter antibiotic therapy duration < 28 days.
Disciplines :
Immunology & infectious disease
Author, co-author :
Ronsin, Charles; Department of Nephrology and Immunology, Nantes University Hospital, Nantes, France
Jouret, François ; Université de Liège - ULiège > Département des sciences cliniques > Néphrologie
Ville, Simon; Department of Nephrology and Immunology, Nantes University Hospital, Nantes, France ; Transplantation and Immunology Research Center, UMR 1064, INSERM, Nantes University, Nantes, France
Abdelmalki, Jihad; Division of Nephrology, Department of Internal Medicine, University of Liège Hospital, Liège, Belgium
Couvrat-Desvergnes, Grégoire; Department of Nephrology, Dialysis, and Transplantation, Departmental Hospital of Vendée, La Roche-sur-Yon, France
Drapeau, Léo; Department of Nephrology, Dialysis, and Transplantation, Departmental Hospital of Vendée, La Roche-sur-Yon, France
Gaisne, Raphael; Department of Nephrology, Saint Nazaire Hospital, Saint Nazaire, France
Gaborit, Benjamin; Department of Infectious Diseases, Nantes University Hospital, Nantes, France
Charlier, Caroline; Department of Infectious Diseases, Cochin University Hospital, Paris, France
Zaidan, Mohamad; Department of Nephrology and Transplantation, Bicêtre Hospital, Le Kremlin-Bicêtre, France
Snanoudj, Renaud; Department of Nephrology and Transplantation, Bicêtre Hospital, Le Kremlin-Bicêtre, France
Giral, Magali; Department of Nephrology and Immunology, Nantes University Hospital, Nantes, France ; Transplantation and Immunology Research Center, UMR 1064, INSERM, Nantes University, Nantes, France
Dantal, Jacques; Department of Nephrology and Immunology, Nantes University Hospital, Nantes, France ; Transplantation and Immunology Research Center, UMR 1064, INSERM, Nantes University, Nantes, France
Knebelmann, Bertrand; Department of Nephrology and Transplantation, Paris Cité University, Necker-Enfants Malades Hospital, Paris, France
Dang, Julien; Department of Nephrology and Transplantation, Bicêtre Hospital, Le Kremlin-Bicêtre, France ; Department of Nephrology and Dialysis, Ambroise Paré Hospital, Boulogne-Billancourt, France
Onori, P., Franchitto, A., Mancinelli, R., et al. Polycystic liver diseases. Dig Liver Dis 42 (2010), 261–271, 10.1016/j.dld.2010.01.006.
Bae, K.T., Zhu, F., Chapman, A.B., et al. Magnetic resonance imaging evaluation of hepatic cysts in early autosomal-dominant polycystic kidney disease: the consortium for radiologic imaging studies of polycystic kidney disease cohort. Clin J Am Soc Nephrol 1 (2006), 64–69, 10.2215/CJN.00080605.
Grünfeld, J.P., Albouze, G., Jungers, P., et al. Liver changes and complications in adult polycystic kidney disease. Adv Nephrol Necker Hosp 14 (1985), 1–20.
Sallée, M., Rafat, C., Zahar, J.R., et al. Cyst infections in patients with autosomal dominant polycystic kidney disease. Clin J Am Soc Nephrol CJASN 4 (2009), 1183–1189, 10.2215/CJN.01870309.
Suwabe, T., Ubara, Y., Higa, Y., et al. Infected hepatic and renal cysts: differential impact on outcome in autosomal dominant polycystic kidney disease. Nephron Clin Pract 112 (2009), c157–c163, 10.1159/000214211.
Suwabe, T., Araoka, H., Ubara, Y., et al. Cyst infection in autosomal dominant polycystic kidney disease: causative microorganisms and susceptibility to lipid-soluble antibiotics. Eur J Clin Microbiol Infect Dis 34 (2015), 1369–1379, 10.1007/s10096-015-2361-6.
Dang, J., Scemla, A., Loheac, C., et al. Efficacy of prolonged antibiotic therapy for renal cyst infections in polycystic kidney disease. Mayo Clin Proc 97 (2022), 1305–1317, 10.1016/j.mayocp.2022.01.027.
Ronsin, C., Chaba, A., Suchanek, O., et al. Incidence, risk factors and outcomes of kidney and liver cyst infection in kidney transplant recipient with ADPKD. Kidney Int Rep 7 (2022), 867–875, 10.1016/j.ekir.2022.01.1062.
Jouret, F., Lhommel, R., Devuyst, O., et al. Diagnosis of cyst infection in patients with autosomal dominant polycystic kidney disease: attributes and limitations of the current modalities. Nephrol Dial Transplant 27 (2012), 3746–3751, 10.1093/ndt/gfs352.
Jouret, F., Hogan, M.C., Chebib, F.T., A practical guide for the management of acute abdominal pain with fever in patients with autosomal dominant polycystic kidney disease. Nephrol Dial Transplant 37 (2022), 1426–1428, 10.1093/ndt/gfab040.
Drenth, J., Barten, T., Hartog, H., Nevens, F., Taubert, R., Balcells, R.T., EASL Clinical Practice Guidelines on the management of cystic liver diseases. J Hepatol 77 (2022), 1083–1108, 10.1016/j.jhep.2022.06.002.
Kidney Disease: Improving Global Outcomes (KDIGO) ADPKD Work Group. KDIGO 2025 clinical practice guideline for the evaluation, management, and treatment of autosomal dominant polycystic kidney disease (ADPKD). Kidney Int, 107, 2025 S1-239 https://doi.org/10.1016/j.kint.2024.07.009.
Lantinga, M.A., Geudens, A., Gevers, T.J.G., Drenth, J.P.H., Systematic review: the management of hepatic cyst infection. Aliment Pharmacol Ther 41 (2015), 253–261, 10.1111/apt.13047.
Telenti, A., Torres, V.E., Gross, J.B., Van Scoy, R.E., Brown, M.L., Hattery, R.R., Hepatic cyst infection in autosomal dominant polycystic kidney disease. Mayo Clin Proc 65 (1990), 933–942, 10.1016/s0025-6196(12)65154-4.
Neuville, M., Hustinx, R., Jacques, J., Krzesinski, J.M., Jouret, F., Diagnostic algorithm in the management of acute febrile abdomen in patients with autosomal dominant polycystic kidney disease. PLoS One, 11, 2016, e0161277, 10.1371/journal.pone.0161277.
Jouret, F., Lhommel, R., Beguin, C., et al. Positron-emission computed tomography in cyst infection diagnosis in patients with autosomal dominant polycystic kidney disease. Clin J Am Soc Nephrol 6 (2011), 1644–1650, 10.2215/CJN.06900810.
Duijzer, R., Bernts, L.H.P., Geerts, A., et al. Clinical management of liver cyst infections: an international, modified Delphi-based clinical decision framework. Lancet Gastroenterol Hepatol 9 (2024), 884–894, 10.1016/S2468-1253(24)00094-3.
Dahabreh, I.J., Kent, D.M., Index event bias: an explanation for the paradoxes of recurrence risk research. JAMA 305 (2011), 822–823, 10.1001/jama.2011.163.
Bobot, M., Ghez, C., Gondouin, B., et al. Diagnostic performance of [(18)F]fluorodeoxyglucose positron emission tomography-computed tomography in cyst infection in patients with autosomal dominant polycystic kidney disease. Clin Microbiol Infect 22 (2016), 71–77, 10.1016/j.cmi.2015.09.024.
Neuville, M.F., Lovinfosse, P., Jadoul, A., et al. The use of a visual 4-point scoring scale improves the yield of 18F-FDG PET-CT imaging in the diagnosis of renal and hepatic cyst infection in patients with autosomal dominant polycystic kidney disease. Eur J Nucl Med Mol Imaging 48 (2021), 254–259, 10.1007/s00259-020-04903-x.
Treglia, G., Albano, D., Rizzo, A., Bellasi, A., Glaudemans, A.W.J.M., Gheysens, O., Performance of [18F]FDG PET/CT in diagnosing cyst infections in patients with autosomal dominant polycystic kidney disease: a systematic review and a bivariate meta-analysis. Diagn Basel Switz, 14, 2024, 1603, 10.3390/diagnostics14151603.
Lantinga, M.A., de Sévaux, R.G.L., Gevers, T.J.G., et al. Clinical predictors of escalating care in hepatic and renal cyst infection in autosomal dominant polycystic kidney and liver disease. Neth J Med 76 (2018), 226–234.
Suwabe, T., Ubara, Y., Sumida, K., et al. Clinical features of cyst infection and hemorrhage in ADPKD: new diagnostic criteria. Clin Exp Nephrol 16 (2012), 892–902, 10.1007/s10157-012-0650-2.
Fantin, B., Duval, X., Massias, L., et al. Ciprofloxacin dosage and emergence of resistance in human commensal bacteria. J Infect Dis 200 (2009), 390–398, 10.1086/600122.
Rodríguez-Baño, J., Navarro, M.D., Romero, L., et al. Risk-factors for emerging bloodstream infections caused by extended-spectrum beta-lactamase-producing Escherichia coli. Clin Microbiol Infect 14 (2008), 180–183, 10.1111/j.1469-0691.2007.01884.x.
Jacoby, G.A., Mechanisms of resistance to quinolones. Clin Infect Dis 41:Suppl 2 (2005), S120–S126, 10.1086/428052.
Bernts, L.H.P., Brüggemann, R.J.M., Jansen, A.M.E., et al. Liver cyst penetration of antibiotics at the target site of infection: a randomized pharmacokinetic trial. J Antimicrob Chemother 80 (2025), 182–191, 10.1093/jac/dkae394.
Lantinga, M.A., Wijnands, T.F.M., Te Morsche, R.H.M., et al. Hepatic cyst penetration of cefazolin in patients receiving aspiration sclerotherapy. J Antimicrob Chemother 71 (2016), 2547–2552, 10.1093/jac/dkw172.
Dauchy, F.A., Dutertre, A., Lawson-Ayayi, S., et al. Interest of [(18)F]fluorodeoxyglucose positron emission tomography/computed tomography for the diagnosis of relapse in patients with spinal infection: a prospective study. Clin Microbiol Infect 22 (2016), 438–443, 10.1016/j.cmi.2015.12.028.
Ronsin, C., Bailly, C., Le Turnier, P., Ville, S., Value of FDG-PET/CT in monitoring cyst infections in patients with autosomal dominant polycystic renal disease. Clin Kidney J 14 (2021), 2273–2275, 10.1093/ckj/sfab077.
Bernts, L.H.P., Dekker, S.E.I., Soonawala, D., et al. Efficacy and safety of selective decontamination of the digestive tract (SDD) to prevent recurrent hepatic cyst infections in polycystic liver disease: a retrospective case series. J Antimicrob Chemother 75 (2020), 2666–2669, 10.1093/jac/dkaa186.
Wittekamp, B.H., Plantinga, N.L., Cooper, B.S., et al. Decontamination strategies and bloodstream infections with antibiotic-resistant microorganisms in ventilated patients: a randomized clinical trial. JAMA 320 (2018), 2087–2098, 10.1001/jama.2018.13765.
