Abstract
BackgroundCyst infection is a common and serious complication of autosomal dominant polycystic kidney disease (ADPKD) that is often refractory. Carbapenems are frequently needed to treat to patients with refractory cyst infection, but little is known about the penetration of newer water-soluble carbapenems into cysts. This study investigated the penetration of meropenem (MEPM) into infected cysts in patients with ADPKD.MethodsBetween August 2013 and January 2014, 10 ADPKD patients (14 infected cysts) receiving MEPM at Toranomon Hospital underwent drainage of infected cysts and definite cyst infection was confirmed through detection of neutrophils by cyst fluid analysis. The serum concentration of MEPM was measured just after intravenous administration and was compared with that in fluid aspirated from infected cysts.ResultsIn the patients undergoing cyst drainage, the mean serum MEPM concentration was 35.2 ± 12.2 μg/mL (range: 19.7 to 59.2 μg/mL, while the mean cyst fluid concentration of MEPM in the drained liver cysts (n = 12) or kidney cysts (n = 2) was 3.03 ± 2.6 μg/mL (range: 0 to 7.3 μg/mL). In addition, the mean cyst fluid/serum MEPM concentration ratio was 9.46 ± 7.19% (range: 0 to 18.8%). There was no relationship between the cyst fluid concentration of MEPM and the time until drainage after MEPM administration or between the cyst fluid/serum MEPM concentration ratio and the time until drainage.ConclusionThese findings suggest that MEPM shows poor penetration into infected cysts in ADPKD patients.Trial registrationThis study was registered with the University Hospital Medical Information Network (UMIN) as “Penetration of meropenem into cysts in patients with autosomal dominant polycystic kidney disease (ADPKD)”, UMIN ID 000011292 on July 26th, 2013.
Highlights
Cyst infection is a common and serious complication of autosomal dominant polycystic kidney disease (ADPKD) that is often refractory
We recently investigated the bacterial pathogens causing cyst infection in ADPKD patients [4], and we found an unexpectedly high prevalence of bacteria that would be unlikely to respond to lipid-soluble antibiotics like fluoroquinolones
Carbapenem therapy may be required for some cyst infections that are resistant to lipid-soluble antibiotics, especially in patients with extended–spectrum beta-lactamase (ESBL)-positive bacteria
Summary
Cyst infection is a common and serious complication of autosomal dominant polycystic kidney disease (ADPKD) that is often refractory. Carbapenems are frequently needed to treat to patients with refractory cyst infection, but little is known about the penetration of newer water-soluble carbapenems into cysts. This study investigated the penetration of meropenem (MEPM) into infected cysts in patients with ADPKD. Cyst infection is a frequent and serious complication of ADPKD, which sometimes becomes resistant to antibiotic therapy and can be fatal [3, 4]. Carbapenem therapy may be required for some cyst infections that are resistant to lipid-soluble antibiotics, especially in patients with ESBL-positive bacteria. Meropenem (MEPM) is a representative carbapenem with a broad spectrum of activity, but little is known about the penetration of such newer carbapenems into the cysts of ADPKD patients. We investigated the penetration of MEPM into infected cysts of ADPKD patients to obtain data that could promote more appropriate and effective use of this antibiotic for cyst infection
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