Email updates

Keep up to date with the latest news and content from BMC Nephrology and BioMed Central.

Open Access Research article

High creatinine clearance in critically ill patients with community-acquired acute infectious meningitis

Alexandre Lautrette12*, Thuy-Nga Phan1, Lemlih Ouchchane23, Ali AitHssain1, Vincent Tixier1, Anne-Elisabeth Heng12 and Bertrand Souweine12

Author affiliations

1 Departments of Intensive Care Unit and Nephrology, University hospital of Clermont-Ferrand, Clermont-Ferrand, France

2 Univ Clermont 1, UFR Médecine, Clermont-Ferrand, F-63001, France

3 Departments of Biostatistics, University hospital of Clermont-Ferrand, Clermont-Ferrand, France

For all author emails, please log on.

Citation and License

BMC Nephrology 2012, 13:124  doi:10.1186/1471-2369-13-124

Published: 27 September 2012

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.

Keywords:
Critically ill; Glomerular filtration rate; High creatinine clearance; Meningitis