title: High creatinine clearance in critically ill patients with community-acquired acute infectious meningitis.
abstract: BACKGROUND
  A high dose of anti-infective agents is recommended when treating infectious meningitis. High creatinine clearance (CrCl) may affect the pharmacokinetic / pharmacodynamic relationships of anti-infective drugs eliminated by the kidneys. We recorded the incidence of high CrCl in intensive care unit (ICU) patients admitted with meningitis and assessed the diagnostic accuracy of two common methods used to identify high CrCl.
  
  
  METHODS
  Observational study performed in consecutive patients admitted with community-acquired acute infectious meningitis (defined by >7 white blood cells/mm3 in cerebral spinal fluid) between January 2006 and December 2009 to one medical ICU. During the first 7 days following ICU admission, CrCl was measured from 24-hr urine samples (24-hr-UV/P creatinine) and estimated according to Cockcroft-Gault formula and the simplified Modification of Diet in Renal Disease (MDRD) equation. High CrCl was defined as CrCl >140 ml/min/1.73 m2 by 24-hr-UV/P creatinine. Diagnostic accuracy was performed with ROC curves analysis.
  
  
  RESULTS
  Thirty two patients were included. High CrCl was present in 8 patients (25%) on ICU admission and in 15 patients (47%) during the first 7 ICU days for a median duration of 3 (1-4) days. For the Cockcroft-Gault formula, the best threshold to predict high CrCl was 101 ml/min/1.73 m2 (sensitivity: 0.96, specificity: 0.75, AUC = 0.90 ± 0.03) with a negative likelihood ratio of 0.06. For the simplified MDRD equation, the best threshold to predict high CrCl was 108 ml/min/1.73 m2 (sensitivity: 0.91, specificity: 0.80, AUC = 0.88 ± 0.03) with a negative likelihood ratio of 0.11. There was no difference between the estimated methods in the diagnostic accuracy of identifying high CrCl (p = 0.30).
  
  
  CONCLUSIONS
  High CrCl is frequently observed in ICU patients admitted with community-acquired acute infectious meningitis. The estimated methods of CrCl could be used as a screening tool to identify high CrCl.
authors.affiliation: Department of Intensive Care Unit, University hospital of Clermont-Ferrand, Clermont-Ferrand, France. alautrette@chu-clermontferrand.fr
authors.forename: Alexandre
authors.initials: A
authors.lastname: Lautrette
authors.forename: Thuy-Nga
authors.initials: TN
authors.lastname: Phan
authors.forename: Lemlih
authors.initials: L
authors.lastname: Ouchchane
authors.forename: Ali
authors.initials: A
authors.lastname: Aithssain
authors.forename: Vincent
authors.initials: V
authors.lastname: Tixier
authors.forename: Anne-Elisabeth
authors.initials: AE
authors.lastname: Heng
authors.forename: Bertrand
authors.initials: B
authors.lastname: Souweine
mesh_terms: D000465:Algorithms; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000652:urine*; D003404:Creatinine / Q000652:urine*; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000652:urine*; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D003404:Creatinine