Effects of meropenem exposure and degradation levels on clinical efficacy in patients with purulent meningitis
- VernacularTitle:美罗培南暴露与降解水平对化脓性脑膜炎疗效的影响
- Author:
Tongtong LI
1
;
Jiantong SUN
1
;
Xianglong CHEN
1
;
Peng DENG
2
;
Yanping XUE
2
;
Yao XIAO
2
;
Lijuan YANG
1
;
Jinhui XU
1
;
Yanxia YU
1
;
Lian TANG
1
Author Information
1. Dept. of Pharmacy，the Affiliated Suzhou Hospital of Nanjing Medical University/Suzhou Municipal Hospital，Jiangsu Suzhou 215002，China
2. Dept. of Neurosurgery，Suzhou Hospital Affiliated to Nanjing Medical University/Suzhou Municipal Hospital，Jiangsu Suzhou 215002，China
- Publication Type:Journal Article
- Keywords:
meropenem;
purulent meningitis;
trough concentration;
open-loop metabolite;
therapeutic effect;
risk factor
- From:
China Pharmacy
2025;36(24):3084-3090
- CountryChina
- Language:Chinese
-
Abstract:
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.
