OBJECTIVE To explore the effects of meropenem exposure and degradation levels on clinical efficacy in patients with purulent meningitis （PM）. METHODS A total of 131 PM patients treated with meropenem at the Affiliated Suzhou Hospital of Nanjing Medical University from January 2022 to June 2025 were prospectively included. Relevant data were collected and divided into a cured group （91 cases） and a non-cured group （40 cases） based on the efficacy. High-performance liquid chromatography-tandem mass spectrometry was used to determine the concentration of meropenem and its open-loop metabolites. Risk factors that affect efficacy were screened， and their predictive power and correlation were evaluated by univariate analysis， and multivariate Logistic regression analysis， receiver operating characteristic （ROC） curves， and correlation analysis. RESULTS Univariate analysis showed that serum creatinine， creatinine clearance rate， minimum inhibitory concentration of meropenem ≥16 μg/mL， cerebrospinal fluid red blood cell count， cerebrospinal fluid white blood cell count， cerebrospinal fluid glucose content， blood trough concentration， blood open-loop metabolite concentration/trough concentration ratio， and intrathecal injection were all correlated with efficacy （P＜0.05）. The results of multiple Logistic regression analysis showed that serum creatinine blood open-loop metabolite concentration/trough concentration ratio， intrathecal injection， and cerebrospinal fluid glucose content were influencing factors for suboptimal anti-infective ltt efficacy （P＜0.05）. ROC curve analysis showed that when the blood open-loop metabolite concentration/trough concentration ratio was greater than 2.854 （AUC＝0.647）， serum creatinine was less than 59.5 μmol/L （AUC＝0.647）， and cerebrospinal fluid glucose content was less than 3.37 mmol/L （AUC＝0.709）， the risk of treatment failure significantly increased （P＜0.05）. Correlation analysis showed that the blood trough concentration of meropenem was positively correlated with the concentration of its open-loop metabolites （R 2＝0.134 5， P＜0.000 1）. CONCLUSIONS Insufficient exposure level and rapid degradation of meropenem are key mechanisms affecting the anti-infective efficacy of PM. Elevated blood open-loop metabolite concentration/ trough concentration ratio， low serum creatinine level， lack of intrathecal injection， and low cerebrospinal fluid glucose content are independent risk factors for poor efficacy.

Objective To investigate the clinical effect of internal fixation and bone graft in surgical reduc-tion of different types of tibial plateau fractures.Methods 90 patients with tibial plateau fractures were selected. They were divided into observation group (60cases) and control group (30cases).The observation group treated with operative reduction of internal fixation and bone grafting for the treatment,and the control group were treated by calca-neal traction and plaster external fixation.The effect,joint function recovery and complication occurrence were com-pared between the two groups.Results The excellent and good rate was 90.00%in the observation group,which was significantly higher than that in the control group (66.67%),the difference was significant (χ2 =11.211 7,P<0.05);The HSS score was respectively (70.3 ±5.9)points and (84.2 ±3.2) at 3 and 6 months after treatment in the observation group,it was significantly higher than that of the control group (t=4.107 3,5.397 1,all P<0.05);the postoperative complication rate was 8.33%in the observation group,which was significantly lower than that in the control group,the difference was significant (χ2 =7.284 3,P<0.05).Conclusion Internal fixation and bone graft in surgical reduction is proved to be effective in treating the patients with different types of tibial plateau fractures.It can promote the recovery of joint function of the patients,which has high safety,and is worthy to be popularized.