Carbapenem Utilization, Resistance Patterns, and Clinical Outcomes Among Critically Ill Patients: Insights from Sudan

Background: Carbapenems are critical antibiotics for the treatment of severe infections in critically ill patients. Inappropriate use promotes resistance, particularly in resource-limited settings such as Sudan. Therefore, this study aimed to assess carbapenem utilization, resistance patterns, and in-ICU (Intensive Care Unit) mortality.
Methods: A retrospective cohort study was conducted in the ICU at Royal Care International Hospital, Khartoum, Sudan, from January to December 2022. The data were collected using a predesigned checklist and analyzed using SPSS v22; categorical variables were compared using the Chi-square test, with P < 0.05 considered significant.
Results: A total of 156 patients were included, most of whom were male (93, 60.0%) and aged >70 years (69, 44.2%). Meropenem was the predominant carbapenem prescribed to 128 (82.0%) patients. Empirical therapy accounted for most prescriptions (141, 90.4%), of which 83% (117/141) were appropriate, while the remaining 17% (24/141) were inappropriate. Positive cultures were obtained from 52 (38.5%) patients, with 24 (20.7%) Pseudomonas spp. and 21 (18.1%) Acinetobacter baumannii as the most common isolates. Resistance was highest in A. baumannii (21/21; 100% resistant to both meropenem and imipenem) and Klebsiella pneumoniae (9/9, 100% to meropenem; 8/9, 88.9% to imipenem), while moderate resistance was observed in Pseudomonas spp. (16/24, 66.7% to meropenem; 13/24, 54.2% to imipenem). Clinical outcomes showed infection control in 56 (35.9%) patients, uncontrolled infection in 27 (17.3%), and death in 69 (44.2%). In an unadjusted analysis, no significant association was found between the type of prescription and clinical outcome (P = 0.33).
Conclusion: Carbapenems were widely prescribed, mostly empirically, with little deescalation and high resistance. Stronger stewardship, timely cultures, and guideline-based use are vital to curb resistance and improve ICU outcomes in resource-limited settings.