ArticleIDCases2026
Management of antimicrobial therapy in culture-negative post-neurosurgical meningitis caused by augmented renal clearance.
Article in IDCases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Augmented renal clearance (ARC) is a well-recognized driver of subtherapeutic antibiotic concentrations in critically ill patients; however, its occurrence in elective neurosurgical populations remains unrecognized. Conventional serum creatinine and conventional intensive care unit (ICU)-based screening tools may fail to identify ARC, leading to antimicrobial failure. Case presentation: A 51-year-old previously healthy woman underwent elective resection of a right cerebellar meningioma. Postoperatively, she developed culture-negative meningitis, with clinical and cerebrospinal fluid findings consistent with bacterial infection. Despite guideline-based vancomycin dosing (escalated to 18.5 mg/kg/dose), serial therapeutic drug monitoring (TDM) revealed persistently subtherapeutic trough concentrations (7.21 and 8.41 µg/mL; target 15-20 µg/mL). Serum creatinine levels remained normal (0.43 mg/dL); calculated creatinine clearance (Cockcroft-Gault) confirmed ARC (131.99 mL/min/1.73 m2), corroborated by 8-h urine collection (135.31 mL/min/1.73 m Conclusions: In culture-negative postoperative meningitis refractory to guideline-based therapy, ARC should be suspected as the underlying cause, specifically for renally eliminated medications. Calculated or estimated creatinine clearance values may underestimate true renal clearance in patients with ARC; therefore, proactive creatinine clearance measurement using timed urine collection is essential. Additionally, TDM-guided dosing and a multimodal composite endpoint are critical for optimal management.
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