The results of the study ‘Efficacy and safety of selective decontamination of the digestive tract (SDD) to prevent recurrent hepatic cyst infections in polycystic liver disease: a retrospective case series’ by Bernts et al. were accepted in Antimicrob Chemother, and posted online ahead of print.The study is a collaborative effort of two ERN RARE-LIVER centers with special interest in ADPKD/ADPLD. Hepatic cyst infection is a severe complication of polycystic liver disease (PLD) that causes substantial morbidity. Recurrent infections are frequent and is increasingly difficult to treat. The authors hypothesized that selective decontamination of the digestive tract (SDD) may reduce recurrence of hepatic cyst infection.
The authors performed a retrospective, observational study in two referral centres for ADPKD/ADPLD. They included eight PLD patients (88% female, 88% polycystic kidney disease) who received SDD with a median SDD treatment duration of 20 months (range: 3–89 months). SDD lowered the median incidence from 0.09 episodes per month (IQR: 0.06–0.25 episodes per month) to 0.01 episodes per month (IQR: 0.00–0.05 episodes per month) (P=0.12). Discontinuation of SDD led to rapid recurrence of cyst infection (71% within 6 weeks). 75% (n = 6) of patients suffered from adverse events that were probably SDD related. These were mild (Grade 1) in three cases consisting of diarrhoea and/or nausea. Severe adverse events (Grade 3) occurred in two, whereof one was severe, irreversible hearing loss probably due to neomycin-induced ototoxicity. In one case, the patient developed polymyxin E resistance.
The authors conclude that SDD prophylaxis provides a novel strategy for limiting recurrent hepatic cyst infection in patients with PLD. However, adverse events deemed related to SDD are frequent. In light of the adverse events associated with aminoglycosides in an ADPKD population with impaired renal function, polymyxin E should be considered the preferred therapy.
Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands.