Anaesthesia, critical care & pain medicine
October 6, 2026 · via Europe PMC
Efficacy of Standard Meropenem Dosing in Healthcare-Associated Meningitis: Is It Universal?
Chauzy A, Dominique C, de Courson H, +15 more, Dahyot-Fizelier C
AI summary — for doctors, generated from the abstract only
Meropenem penetrates poorly into CSF, and 6 g/day appears sufficient for some Gram-negative CNS infections but not all.
What was studied
A multicentre PK/PD study in 28 neuro-ICU patients with external ventricular drains on 6-8 g/day meropenem, 14 with CNS infection and 14 with extra-CNS infection, plus Monte Carlo simulations.
Key findings
- CSF/plasma AUC ratio was 16.3% in CNS infection vs 6.0% in extra-CNS infection
- With CNS infection, target attainment exceeded 90% for MIC up to 0.25 mg/L at 6 g/day and reached 89.7% at 8 g/day for MIC 1 mg/L
- 6 g/day appears sufficient for E. cloacae, K. pneumoniae and S. marcescens, but the text is truncated for other pathogens
Clinical relevance
Standard dosing may be inadequate for higher-MIC organisms in EVD-related infection.
Who should care
Limitations
Only 28 patients and the simulation relies on modelled estimates; abstract is truncated.
Consider dose optimisation and MIC knowledge when treating EVD-related Gram-negative infection with meropenem.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Central nervous system (CNS) infections related to external ventricular drains (EVD) represent a frequent and serious complication of invasive CNS procedures, particularly those due to Gram-negative bacilli (GNB). Meropenem is one of the first-line treatments recommended whereas its limited CSF diffusion, with few studies with proven CNS infections. The multicenter PK/PD study evaluated the impact of EVD-related infections on meropenem distribution in cerebrospinal fluid (CSF) in 28 neuro-ICU patients with EVD, receiving meropenem via intermittent or continuous infusions (6-8 g/day), by comparing patients with confirmed CNS infection (n = 14) to those with extra-CNS infection (n = 14). Theoretical efficacy of different dosing strategies was assessed by Monte Carlo simulations. Probability of target attainment (PTA) and cumulative fractions of response (CFRs) were derived as the percentage of individuals achieving at steady-state 100% T > MIC for each dosing regimen using meropenem MIC frequency distributions for P. aeruginosa, K. pneumoniae, E. cloacae, and S. marcescens. A limited penetration of meropenem into CSF was observed, with a CSF/plasma AUC ratio of 16.3 ± 11.4% in CNS infections compared to 6.0 ± 4.5% in extra-CNS infections, highlighting the significant impact of infection. In patients with CNS infection, PTA in CSF was> 90% for MIC up to 0.25 mg/L with 6 g/d and reached 89.7% with 8 g/d for MIC of 1 mg/L. Overall, a daily dose of 6 g appears sufficient to treat CNS infections caused by E. cloacae, K. pneumoniae, and S. marcescens, whereas none of the dosing regimens tested seem adequate for P. aeruginosa, which more frequently exhibits high MICs > 1 mg/L.
DOI
10.1016/j.accpm.2026.101936
PMID
42838361
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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