Yan Ziyan, Wang Yuchen, Zeng Wenli, Hui Jialiang, Yang Bin, Xu Jian, Miao Yun, Xia Renfei
Department of Transplantation, Nanfang Hospital, Southern Medical Univerisity, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
Center for Infectious Diseases Vision Medicals Co., Ltd., Guangzhou, China.
BMC Infect Dis. 2025 Mar 27;25(1):423. doi: 10.1186/s12879-025-10804-x.
Retaining the native bilateral kidneys after transplantation is a common treatment for patients with end-stage autosomal dominant polycystic kidney disease. However, this strategy poses the risks of potential complications from polycystic kidney infection. The efficiency of antibiotic therapy and the optimal time for native nephrectomy in managing these infections remain uncertain.
We report a case of a kidney transplant recipient with retained bilateral polycystic kidneys who experienced recurrent cyst and bloodstream infections, accompanied by antibiotic-driven pathogen replacement. After multiple failed attempts at antibiotic therapy, the patient subsequently underwent unilateral polycystic kidney resection. Subsequently, a new infection episode occurred, leading to the other native nephrectomy. Cystic tissue and fluid samples were collected from both shallow and deep layers of the polycystic kidneys, along with peripheral blood and urine samples. These samples were analyzed using microbial culture, metagenome sequencing, and digital polymerase chain reaction to identify infectious pathogens. Pathogen replacement occurred across different infection episodes, with the dominant bacterial species being Escherichia coli, Klebsiella aerogenes, and Enterococcus faecium, in succession.
This case highlights the replacement of dominant pathogens under antibiotic selection pressure in polycystic kidney infections, primarily involving gram-negative bacilli. When initial and subsequent antibiotic therapy fail, re-evaluation of the cyst infection definition is necessary, and preemptive native nephrectomy should be considered.
肾移植后保留双侧原生肾是终末期常染色体显性多囊肾病患者的常见治疗方法。然而，该策略存在多囊肾感染引发潜在并发症的风险。抗生素治疗的效果以及在处理这些感染时进行原生肾切除术的最佳时机仍不明确。
我们报告一例肾移植受者，其双侧多囊肾得以保留，但经历了反复的囊肿和血流感染，并伴有抗生素驱动的病原体更替。在多次抗生素治疗尝试失败后，患者随后接受了单侧多囊肾切除术。随后，又发生了一次新的感染发作，导致另一侧原生肾被切除。从多囊肾的浅层和深层收集了囊性组织和液体样本，以及外周血和尿液样本。使用微生物培养、宏基因组测序和数字聚合酶链反应对这些样本进行分析，以鉴定感染病原体。在不同的感染发作中出现了病原体更替，优势细菌种类依次为大肠杆菌、产气克雷伯菌和粪肠球菌。
本病例突出了多囊肾感染在抗生素选择压力下优势病原体的更替，主要涉及革兰氏阴性杆菌。当初始及后续抗生素治疗失败时，有必要重新评估囊肿感染的定义，并应考虑进行预防性原生肾切除术。
