Liver Cyst Infection Outcomes in Patients With ADPKD

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.

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.

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).

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.