High-dose versus standard-dose intermittent meropenem in critically ill patients: An observational cohort study
Authors' conclusion
High-dose intermittent meropenem was independently associated with lower 90-day all-cause mortality compared with standard-dose therapy in critically ill patients.
Study context
- Population
- Critically ill patients with intensive care unit (ICU) stay ≥3 days treated with meropenem, Vienna, Austria, March 2014 to March 2024received meropenem
- Participants
- 4,210 patients
- Exposure
- High-dose vs standard-dose intermittent meropenem
- High-dosen = 1,144
- Standard-dosen = 572reference
- Outcome
- All-cause mortality
- Follow-up
- 90 days
Methodological details2:1 propensity score matching with covariate adjustment
- 2:1 propensity score matching with covariate adjustment
Main finding
90-day all-cause mortality
Adjusted risk difference
9.4%
95% CI 4.8–14.1
P < 0.001
By group
High-dose vs Standard-dose
adjusted risk difference 9.4% (95% CI 4.8–14.1); P < 0.001
As reported in the abstract
Observational data: associations, not effects.
Secondary outcomes
ICU LOS
Hospital LOS
Adjusted risk
| Outcome | High-dose | Standard-dose |
|---|---|---|
| 30-day mortality | 20.0% | 22.2% |
| Resistance emergence | 5.0% | 6.2% |
| ECMO initiation | 6.1% | 7.3% |
| New-onset ARDS | 20.8% | 24.9% |
30-day mortality
- No significant difference
Resistance emergence
- No significant difference
Extracorporeal membrane oxygenation (ECMO) initiation
- No significant difference
New-onset acute respiratory distress syndrome (ARDS)
- No significant difference
ICU LOS
- Comparable
Hospital LOS
- Comparable
Safety
Adjusted risk
| Outcome | High-dose | Standard-dose |
|---|---|---|
| AKI | 60.6% | 68.2% |
Acute kidney injury (AKI)
- High-dose associated with lower adjusted risk of AKI
Original publication
High-dose versus standard-dose intermittent meropenem in critically ill patients: An observational cohort study. Ann Intensive Care. Published 16 January 2026. doi:10.
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