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Systematic review: the management of hepatic cyst infection
M A Lantinga1, A Geudens, T J G Gevers
1Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands.
Insights
Hepatic cyst infection treatment is highly variable. Oral ciprofloxacin is recommended initially, with percutaneous drainage considered for treatment failures. Recurrence is common, especially in transplant recipients.
Area of Science:
- Hepatology
- Infectious Diseases
- Surgical Gastroenterology
Background:
- Hepatic cyst infection is a serious complication of hepatic cystic disease.
- Current treatment strategies lack evidence-based guidelines.
Purpose of the Study:
- To systematically review and synthesize evidence on treatment strategies for de novo hepatic cyst infection.
- To provide evidence-based treatment recommendations.
Main Methods:
- Systematic literature search of PubMed, EMBASE, and Cochrane Library (up to 2014).
- Inclusion of human studies (≥18 years) on hepatic cyst infection treatment.
- Data extraction on patient demographics, treatments, and outcomes.
Main Results:
- Analysis of 54 cases from 41 case series/reports, indicating high bias.
- Initial treatments included antimicrobials (56%), percutaneous drainage (31%), and surgery (13%).
- Antimicrobial failure occurred in 70%, necessitating further intervention; recurrence rates were 20%, with higher incidence in renal transplant recipients.
Conclusions:
- Hepatic cyst infection treatment is highly heterogeneous.
- Recommend oral ciprofloxacin as first-line therapy.
- Percutaneous cyst drainage is advised for treatment failures.
Background:
Cyst infection is a severe complication of hepatic cystic disease. However, an evidence-based treatment strategy is not available.
Aim:
To assess the available treatment strategies and provide a treatment advice for de novo hepatic cyst infection.
Methods:
We systematically searched PubMed (1948-2014), EMBASE (1974-2014), and the Cochrane Library (until 2014) for studies involving humans (≥18 years) treated for a hepatic cyst infection. We extracted data on patient characteristics, treatment and follow-up.
Results:
We identified 41 articles; all were case series or case reports, implicating a high risk of bias. We included 54 hepatic cyst infection cases (male 39%; mean age 63 ± 12 years; diabetes 6%; dialysis 19%; transplant recipients 30%). Initial therapy consisted of antimicrobial (56%), percutaneous (31%) or surgical treatment (13%). We identified 42 antimicrobial regimens consisting of 23 different combinations. Most used antibiotic classes were quinolones (34%) and cephalosporins (34%). Antimicrobials failed in 70% of cases, eventually requiring percutaneous or surgical treatment in, respectively, 37% and 27%. Recurrent hepatic cyst infection was frequent (20%). Median time to recurrence was 8 weeks (IQR 3-24 weeks). In 46%, recurrence occurred in renal transplant recipients. Cyst infection related deaths occurred in 9%, of whom 40% were on dialysis.
Conclusions:
The literature shows that treatment of hepatic cyst infection is highly heterogeneous. We recommend first line treatment with oral ciprofloxacin. In case of failure, percutaneous cyst drainage needs to be considered.
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