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ADPKD Cyst Infection Lipophilic Antibiotic — ESENeph MCQ

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ModeratePolycystic Kidney DiseaseADPKD Cyst Infection Lipophilic AntibioticESENeph

A 45-year-old woman with ADPKD develops right flank pain, fever (38.8°C), and rigors. CT shows a 6 cm right renal cyst with thickened wall and surrounding perinephric fat stranding. Blood cultures are positive for Escherichia coli. Previous cultures from 6 months ago also grew E. coli from a cyst aspiration. What antibiotic property is MOST important for treating infected cysts in ADPKD?

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Correct answer: D — Lipophilicity for cyst wall penetration

The epithelial lining of renal cysts in ADPKD acts as a barrier to many antibiotics. Lipophilic antibiotics (fluoroquinolones, trimethoprim-sulfamethoxazole, chloramphenicol, metronidazole) penetrate cyst walls far more effectively than hydrophilic agents (beta-lactams, aminoglycosides). Despite E. coli being typically susceptible to many antibiotics, treatment failure with beta-lactams is common in cyst infections because they achieve inadequate intra-cyst concentrations. Ciprofloxacin or co-trimoxazole are preferred first-line agents. Treatment duration is typically 4-6 weeks. If fever persists beyond 72 hours, cyst drainage should be considered.

Reference: Lantinga et al 2017 – ADPKD Cyst Infection Management; ERA-EDTA 2015 – ADPKD Management