Meropenem Exposure, Target Attainment, and Therapeutic Drug Monitoring Practices in Critically Ill Adults Receiving Continuous Renal Replacement Therapy: A Systematic Review.

OBJECTIVE

To critically evaluate meropenem pharmacokinetics/pharmacodynamics (PK/PD) target attainment, therapeutic drug monitoring (TDM), infusion strategies, and clinical outcomes during continuous renal replacement therapy (CRRT).

DATA SOURCES: Ovid MEDLINE, PubMed, Scopus, Web of Science, and the Cochrane Library were searched from inception to August 15, 2026, using meropenem, TDM, β-lactam, and CRRT terms, with adult, human, and English-language limits.

STUDY SELECTION AND DATA EXTRACTION: Thirteen reports representing 12 unique studies (2 randomized, 10 non-randomized) reporting meropenem concentration data during CRRT were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2 or ROBINS-I.

DATA SYNTHESIS: Total clearance ranged from 3.60 to 6.6 L/h. Lower or primary PK/PD target non-attainment ranged from 0% to 26.7%, while aggressive-target non-attainment ranged from 0% to 53.3% in most analyses and reached 93% in 1 study when a minimum inhibitory concentration (MIC) of 8 mg/L was assumed. Continuous or prolonged infusion may facilitate sustained exposure, but comparative evidence was limited. Four used routine TDM; only 2 implemented protocolized TDM-guided dose adjustment. Low exposure was associated with higher mortality in 1 adjusted observational analysis, but evidence for clinical outcomes was of very low certainty.

RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Standardized meropenem regimens cannot be assumed to provide consistent exposure during CRRT. Optimized infusion and timely, protocolized TDM may support individualized dosing when multidisciplinary expertise is available.

CONCLUSIONS

Available evidence supports a shift from standardized empirical dosing toward individualized, measurement-guided meropenem therapy in patients receiving CRRT.