Snapshot A 65-year-old man is admitted to the medical intensive care unit for management of sepsis. He was started on empiric antibiotic treatment with vancomycin and piperacillin-tazobactam after blood cultures were obtained. His temperature is 102°F (38.9°C), blood pressure is 79/65 mmHg, pulse is 120/min, and respirations are 22/min. Blood culture grow Pseudomonas aeruginosa which is sensitive to meropenem and his antibiotics are narrowed. Introduction Mechanism of action binds to penicillin-binding proteins (PBPs) inhibiting transpeptidation impairs peptidoglycan synthesis, a needed component of cell wall biosynthesis Mechanism of resistance carbapenemase production altered PBPs Drugs doripenem imipenem must be administered with cilastatin (a renal dehydropeptidase I inhibitor) to prevent its metabolism in the renal tubules meropenem ertapenem Clinical use gram-positive cocci gram-negative rods anaerobes preferably used in the setting of a life-threatening infection or when other antibiotic therapies have failed Adverse effects seizures meropenem is the carbapenem that has a decreased risk of seizure gastrointestinal distress rash