Research Information System
European Journal of Hospital Pharmacy, 2026 (SCI-Expanded, Scopus)
Purpose: This study aimed to measure meropenem trough concentrations, assess their association with outcomes, and develop a clinical prediction score for optimal drug levels. Methods: In this retrospective single centre cohort study, we analysed 543 meropenem concentrations from 331 patients. Targets were defined as 100% fT>MIC (duration of time the drug concentration remains above the minimum inhibitory concentration) and 100% fT>4×MIC. A predictive scoring system was developed using logistic regression and validated via receiver operating characteristic (ROC) analysis. Propensity score matching (PSM) and inverse probability treatment weighting were applied. Results: The target was reached in 73.8% of measurements for 100% fT>MIC and 48.8% for 100% fT>4×MIC. While the clinical cure rates were not different in patients with pharmacokinetic/pharmacodynamic (PK/PD) target attainment, microbiological cure rates were higher in case of achieving 100% fT>MIC and 100% fT>4×MIC (p<0.001). According to the multivariate logistic regression analysis, the best predictors of achieving the meropenem PK/PD target of 100% fT>MIC and >4×MIC were 6 g/24 hour loading dose, estimated glomerular filtration rate (eGFR) and age. While a 6 g/24 hour loading dose and older age were associated with higher target attainment, elevated eGFR correlated with lower serum levels. The prediction score derived by using these parameters had a sensitivity of 71.2%, specificity of 67.6%, positive predictive value of 86.1%, negative predictive value of 45.5% and accuracy of 70.2%. There is a trend towards clinical cure and target attainment according to PSM analysis. Conclusions: Three-quarters of the measurements achieved the PK/PD target of 100% fT>MIC, while half achieved the more stringent target of 100% fT>4×MIC, highlighting the need for optimised dosing strategies. Target achievement rates can be improved with therapeutic drug monitoring and personalised dosing approaches are needed.