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High-dose versus standard-dose intermittent meropenem in critically ill patients: An observational cohort study

Felix Bergmann1, Marlene Prager1,2, Lena Pracher1

  • 1Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.

Annals of Intensive Care
|March 6, 2026
PubMed
Abstract

Insights

High-dose meropenem significantly reduced 90-day mortality in critically ill patients compared to standard doses. This study suggests high-dose meropenem may improve survival outcomes for critically ill patients.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • The optimal meropenem dosage for critically ill patients is not well-established.
  • Uncertainty exists regarding the impact of high-dose versus standard-dose meropenem on patient outcomes.

Purpose of the Study:

  • To compare the effectiveness of high-dose (6 g/day) versus standard-dose (3 g/day) meropenem.
  • To evaluate the impact of meropenem dosing on 90-day mortality and other clinical outcomes in critically ill patients.

Main Methods:

  • Observational cohort study in Vienna, Austria (March 2014-March 2024).
  • Included critically ill patients with ICU stay ≥3 days, treated with high-dose or standard-dose meropenem.
  • Propensity score matching (2:1) and covariate adjustment were used to control for confounding factors.

Main Results:

  • 90-day all-cause mortality was significantly lower in the high-dose meropenem group (31.5%) compared to the standard-dose group (40.9%).
  • No significant differences were observed in 30-day mortality, resistance emergence, ECMO initiation, or ARDS onset between groups.
  • High-dose therapy was associated with a lower adjusted risk of acute kidney injury (AKI).

Conclusions:

  • High-dose intermittent meropenem administration is independently associated with reduced 90-day all-cause mortality in critically ill patients.
  • The findings suggest a potential survival benefit of high-dose meropenem in this patient population.
Keywords:
AntibioticAntimicrobialPharmacokineticsPneumoniaSepsis

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