{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T21:37:42Z","timestamp":1792705062223,"version":"4.5.0"},"reference-count":46,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100004515","name":"Universiti Kebangsaan Malaysia","doi-asserted-by":"publisher","award":["Geran Galakan Penyelidik Muda (GGPM) \/ GGPM-2022-0"],"award-info":[{"award-number":["Geran Galakan Penyelidik Muda (GGPM) \/ GGPM-2022-0"]}],"id":[{"id":"10.13039\/501100004515","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Pharmacother"],"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To critically evaluate meropenem pharmacokinetics\/pharmacodynamics (PK\/PD) target attainment, therapeutic drug monitoring (TDM), infusion strategies, and clinical outcomes during continuous renal replacement therapy (CRRT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources:<\/jats:title>\n                    <jats:p>Ovid MEDLINE, PubMed, Scopus, Web of Science, and the Cochrane Library were searched from inception to August 15, 2026, using meropenem, TDM, \u03b2-lactam, and CRRT terms, with adult, human, and English-language limits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Selection and Data Extraction:<\/jats:title>\n                    <jats:p>Thirteen reports representing 12 unique studies (2 randomized, 10 non-randomized) reporting meropenem concentration data during CRRT were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2 or ROBINS-I.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Synthesis:<\/jats:title>\n                    <jats:p>Total clearance ranged from 3.60 to 6.6\u2009L\/h. Lower or primary PK\/PD target non-attainment ranged from 0% to 26.7%, while aggressive-target non-attainment ranged from 0% to 53.3% in most analyses and reached 93% in 1 study when a minimum inhibitory concentration (MIC) of 8\u2009mg\/L was assumed. Continuous or prolonged infusion may facilitate sustained exposure, but comparative evidence was limited. Four used routine TDM; only 2 implemented protocolized TDM-guided dose adjustment. Low exposure was associated with higher mortality in 1 adjusted observational analysis, but evidence for clinical outcomes was of very low certainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Patient Care and Clinical Practice:<\/jats:title>\n                    <jats:p>Standardized meropenem regimens cannot be assumed to provide consistent exposure during CRRT. Optimized infusion and timely, protocolized TDM may support individualized dosing when multidisciplinary expertise is available.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Available evidence supports a shift from standardized empirical dosing toward individualized, measurement-guided meropenem therapy in patients receiving CRRT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10600280261489958","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T05:53:08Z","timestamp":1792475588000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Meropenem Exposure, Target Attainment, and Therapeutic Drug Monitoring Practices in Critically Ill Adults Receiving Continuous Renal Replacement Therapy: A Systematic Review"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4984-0169","authenticated-orcid":false,"given":"Nazatul Adhwa","family":"Mohd Rozi","sequence":"first","affiliation":[{"name":"Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2102-342X","authenticated-orcid":false,"given":"Lim","family":"Jia Hui","sequence":"additional","affiliation":[{"name":"Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6243-6975","authenticated-orcid":false,"given":"Shamin","family":"Saffian","sequence":"additional","affiliation":[{"name":"Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohd","family":"Makmor-Bakry","sequence":"additional","affiliation":[{"name":"Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3494-3010","authenticated-orcid":false,"given":"Aliza","family":"Mohamad Yusof","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, Faculty of Medicine and Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruslinda","family":"Mustafar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5559-203X","authenticated-orcid":false,"given":"Muhammad Nordin","family":"M Saud","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7330-7148","authenticated-orcid":false,"given":"Nor Asyikin","family":"Mohd Tahir","sequence":"additional","affiliation":[{"name":"Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"e_1_3_5_2_2","first-page":"7","volume-title":"Critical Care Self-Assessment Program (CCSAP) 2017 Book 2: Renal\/pulmonary Critical Care","author":"Awdishu L","unstructured":"Awdishu L, Wu SE. Acute kidney injury. In: Boucher BA, Haas CE, eds. Critical Care Self-Assessment Program (CCSAP) 2017 Book 2: Renal\/pulmonary Critical Care. American College of Clinical Pharmacy (ACCP); 2017:7-26."},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics11121769"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2016.03.427"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1086\/444500"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0287"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-12-152"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1128\/aac.00296-11"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1128\/aac.01312-22"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1086\/516284"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-017-1871-2"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1594.2003.07283.x"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200544100-00002"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2018.09.004"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007691-200502000-00004"},{"key":"e_1_3_5_16_2","volume-title":"Pharmacokinetics Made Easy","author":"Birkett DJ.","year":"2002","unstructured":"Birkett DJ. Pharmacokinetics Made Easy. Rev ed. McGraw Hill; 2002."},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics12071112"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-008-1034-7"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2014.09.009"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics13080755"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s43440-019-00056-3"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-015-0818-8"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e318241e553"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa224"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2019.02.007"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc13886"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2017.01.009"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics12101524"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1177\/03000605261457800"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-025-02554-4"},{"key":"e_1_3_5_32_2","doi-asserted-by":"publisher","DOI":"10.1159\/000529694"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics13090849"},{"key":"e_1_3_5_34_2","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200847030-00003"},{"key":"e_1_3_5_35_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40780-025-00425-6"},{"key":"e_1_3_5_36_2","doi-asserted-by":"publisher","DOI":"10.1097\/ftd.0000000000000741"},{"key":"e_1_3_5_37_2","doi-asserted-by":"publisher","DOI":"10.1155\/2024\/1837150"},{"key":"e_1_3_5_38_2","doi-asserted-by":"publisher","DOI":"10.1177\/0018578718779009"},{"key":"e_1_3_5_39_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0102023"},{"key":"e_1_3_5_40_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.833189"},{"key":"e_1_3_5_41_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics14010092"},{"key":"e_1_3_5_42_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2019.05.026"},{"key":"e_1_3_5_43_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.74356"},{"key":"e_1_3_5_44_2","doi-asserted-by":"publisher","DOI":"10.1097\/ftd.0000000000000937"},{"key":"e_1_3_5_45_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.992354"},{"key":"e_1_3_5_46_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.838205"},{"key":"e_1_3_5_47_2","doi-asserted-by":"publisher","DOI":"10.1128\/aac.00104-23"}],"container-title":["Annals of Pharmacotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10600280261489958","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10600280261489958","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10600280261489958","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T20:48:23Z","timestamp":1792702103000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10600280261489958"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,19]]},"references-count":46,"alternative-id":["10.1177\/10600280261489958"],"URL":"https:\/\/doi.org\/10.1177\/10600280261489958","relation":{},"ISSN":["1060-0280","1542-6270"],"issn-type":[{"value":"1060-0280","type":"print"},{"value":"1542-6270","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,19]]},"article-number":"10600280261489958"}}