Prolonged infusion of meropenem for suspected intracystic infection in polycystic kidney disease during pregnancy: a case report

BackgroundIntrarenal cyst infection in polycystic kidney disease (PKD) is hard to confirm and harder to treat during pregnancy, when lipid-soluble antibiotics are generally avoided.CaseA pregnant woman at approximately 10 weeks’ gestation presented with recurrent fever and flank pain for over one month, with acute exacerbation one day prior to admission. Laboratory tests revealed progressively elevated C-reactive protein (CRP) levels despite repeatedly negative cultures. Serial ultrasound showed a right upper-pole renal cyst that evolved to exhibit internal septations and debris.Treatment and outcomeCyst aspiration was avoided; meropenem 1 g every 8 h was initiated on admission and converted to prolonged infusion (1 g infused over more than 3 h) on Day 4, followed by step-down oral amoxicillin–clavulanate, for a total antimicrobial course of 32 days. Fever resolved and CRP normalized; pregnancy continued uneventfully.ConclusionIn a pregnant patient with suspected PKD cyst infection, prolonged-infusion meropenem was followed by clinical improvement. The favorable response observed supports further evaluation of this therapeutic strategy, despite the absence of microbiological confirmation.