Background As a restricted antimicrobial, lessons learned from real-life meropenem usage will be applicable to antimicrobial stewardship (AMS) more generally. Objective To retrospectively evaluate meropenem usage at our institution to identify targets for AMS interventions. Methods Patients receiving meropenem documented with an ‘alert antimicrobial’ form at two tertiary care U.K. hospitals were identified retrospectively. Clinical records and microbiology results were reviewed. Results 107 adult inpatients receiving meropenem were identified. This was first-line in 47% and escalation therapy in 53%. Source control was required in 28% of cases after escalation, for predictable reasons. Those ultimately requiring source control had received more prior antimicrobial agents than those not (p=0.03). Meropenem was rationalised in 24% of cases (after median four days). Positive microbiology enabled rationalisation (OR 12.3, 95% CI 2.7-55.5, p=0.001) but rates of appropriate sampling varied. In cases with positive microbiology where meropenem was not rationalised, continuation was retrospectively considered clinically and microbiologically necessary in 8/40 cases (0/17 empiric first-line usage). Rationalisation was more likely when meropenem susceptibility was not released on the microbiology report (OR 5.2, 95% CI 1.3-20.2, p=0.02). Input from an infection specialist was associated with a reduced duration of meropenem therapy (p<0.0001). Early review by an infection specialist has the potential to further facilitate rationalisation. Conclusions In real-life clinical practice, core aspects of infection management remain tractable targets for AMS interventions: microbiological sampling, source control, and infection specialist input. Further targets include supporting rationalisation to less familiar carbapenem-sparing antimicrobials, restricting first-line meropenem usage and selectively reporting meropenem susceptibility.