Abstract
OBJECTIVES: The effectiveness of prolonged infusion of meropenem in treating sepsis remains debated. This meta-analysis aims to compare the clinical effectiveness and safety of prolonged infusion versus short-term infusion of meropenem in sepsis patients. METHODS: A systematic search was conducted in PubMed, Web of Science, ClinicalTrials.gov, and the Cochrane Library for randomized controlled trials (RCTs) and observational studies published from database inception up to February 2025. Studies meeting the inclusion and exclusion criteria were included. Data were extracted in prespecified forms, and fixed-effect or random-effects models were used based on I2 values. This meta-analysis is registered with the PROSPERO database and follows the Preferred Reporting Items for Systematic and Meta-Analyses reporting guidelines. RESULTS: A total of 1597 articles were identified and screened, leading to the inclusion of 18 studies (3703 patients) in the meta-analysis. Prolonged infusion of the meropenem was associated with a reduced risk of mortality compared to short-term infusion (risk ratio [RR] = 0.85, 95% confidence interval [CI] = 0.76-0.95). No significant heterogeneity was observed ( P = 0.24, I2 = 19%). Furthermore, prolonged infusion is associated with a higher rate of clinical cure (RR = 1.35, 95% CI = 1.25-1.47). Additionally, the group receiving prolonged infusions demonstrated a higher microbiological eradication rate (RR = 1.13, 95% CI = 1.04-1.22). CONCLUSIONS: Administering meropenem via prolonged infusion to sepsis patients is associated with short-term survival benefits, an increased likelihood of clinical cure, and greater microbiological eradication. Further high-quality RCTs are needed to determine the potential long-term survival benefits of prolonged meropenem infusion in sepsis patients.