常染色体显性遗传多囊肾病肾囊肿感染43例次临床分析

目的 总结常染色体显性遗传多囊肾病（ADPKD）肾囊肿感染的临床特点和治疗结果。 方法 回顾性分析本院1991年1月1日至2010年12月31日期间收治住院的ADPKD肾囊肿感染患者43例次的临床资料，比较前后10年间病原菌及耐药情况的变迁、患者治疗结果的差异。 结果 20 年间共有473例 662例次ADPKD患者收治入院，其中40例发生了 43 次肾囊肿感染，8例次为确诊病例，35例次为疑似病例。43例次肾囊肿感染中34例次（79.0%）病原学培养阳性，其中大肠埃希菌检出率最高，占82.4%。后10年与前10年相比，大肠埃希菌对喹诺酮类和部分β-内酰胺类抗生素的耐药性明显增加。起始经验性抗生素治疗有效性为69.8%，起始联合用药较单药治疗有效率高（75.0%比65.2%，P < 0.05）。前10年组，初始联合用药比例为30.0%，有效率为60.0%，住院时间为（20.2±6.7） d；后10年组的初始治疗联合用药比例和有效率提高，分别为61.9%和78.2%，住院时间缩短至（16.3±3.2） d。对于直径>5 cm的囊肿感染常需要穿刺抽液治疗。 结论 ADPKD肾囊肿感染的主要致病菌为革兰阴性杆菌，初始经验治疗常需联合用药，必要时行囊肿穿刺抽液治疗。随着对该并发症认识的加深，治疗效果不断提高。

Clinical analysis of 43 episodes of cyst infection in autosomal dominant polycystic kidney disease

Objective To summarize the clinical characteristics and outcome of renal cyst infection in patients with autosomal dominant polycystic kidney disease (ADPKD). Methods Clinical data of 40 ADPKD patients with 43 episodes of renal cyst infection admitted in Shanghai Changzheng Hospital from 1st January 1991 to 31st December 2010 were retrospectively analyzed. Differences of microbiological data and treatments between 1st January 1991 to 31st December 2000 and 1st January 2001 to 31st December 2010 were compared. Results Among 473 identified patients with ADPKD and 662 episodes of hospitalization, 40 patients had 43 episodes of renal cyst infection, including 8 definite and 35 likely cases. Microbiological documentation was available for 34 episodes (79.0%), Escherichia coli accounting for 82.4% of all retrieved bacterial strains. Resistant Escherichia coli to quinolone and certain β-lactamine increased in recent decade. Clinical efficacy of initial antibiotic treatment was noted in 69.8% of episodes. Antibiotic treatment modification was more frequently required for patients receiving initial monotherapy compared with those receiving combination therapy. In the first ten-year group, initial combination therapy and clinical efficacy were noted in 30.0% and 60.0% of episodes respectively, and hospital stay was (20.2±6.7) d. In the second ten-year group, initial combination therapy and clinical efficacy were noted in 61.9% and 78.2% of episodes respectively, and hospital stay was (16.3±3.2) d. Large infected cysts (diameter >5 cm) frequently required drainage. Conclusions In renal cyst infection, the source of the organisms is often a gram negative enteric organism. Empiric therapy is often initiated with two antibiotics. The drainage of large infected cysts remains the main treatment for cyst infection.