Severe infection is a significant threat to patient safety and survival. As the main treatment for hospital acquired infections, meropenem is limited in its effectiveness due to the emergence of drug resistance, especially after long-term use of antibiotics. Therefore, optimizing the efficacy of antibiotics such as meropenem and avoiding microbial resistance has become an urgent issue to be addressed. Therapeutic drug monitoring (TDM), as an important tool for achieving personalized drug administration, is increasingly recognized as an important strategy for optimizing antibiotic concentration, avoiding treatment failure and toxicity in critically ill patients and patients with renal insufficiency. By reviewing the current application status, pharmacokinetics, and TDM guidance of meropenem, clinical references are provided for the treatment of critically ill patients and patients with renal insufficiency, and guidance and support are provided for optimizing antibiotic treatment.