Abstract：Objective To compare the safety of carbapenem drug meropenem (MPEM) and imipenem-cilastatin (IPM/CST) in the treatment of severe infections and to provide a safety basis for clinical drug selection. Methods CNKI, Weipu, Wanfang, CBM, and Pubmed were searched to collects RCTs of randomized controlled trials on MPEM and IPM / CST in the treatment of severe infections published at home and abroad since 1990. RevMan 5.3 software was used to evaluate the safety. Results 41 literatures were selected. The overall results showed that the incidence of adverse reactions of meropenem in the treatment of severe infections was not lower than imipenem/cilastatin (Z=1.99, P=0.05). In subgroup analysis, the incidence of adverse reactions of meropenem was lower than that of imipenem/cilastatin in the treatment of lower respiratory tract infections (Z=2.54, P=0.01<0.05). There was no significant difference in the incidence of adverse reactions in the treatment of abdominal infections (Z=0.79, P=0.43>0.05). Symptoms of adverse reactions showed that digestive system was the most common, followed by the circulatory system, skin, and the injection part. Meropenem caused more rashes than imipenem/cilastatin, while imipenem/cilastatin caused more adverse reactions in other systems. Conclusions The rate of adverse reactions of meropenem and imipenem/cilastatin in the treatment of severe infections was similar, it was lower only in the lower respiratory tract infections. Meropenem was more common than imipenem/cilastatin in the occurrence of rash, but other symptoms were lower than imipenem/cilastatin.