AUTHOR=Kanwal Uroosa , Muhammad Iyad Naeem , Zehra Ale , Shah Syed Shaukat Ali Muttaqi , Abro Falak , Ansari Tehreem , Rahim Najia , Munawar Rabya , Hussain Mujahid 
  
TITLE=Carbapenem-based versus non-carbapenem therapy for hospital-acquired and ventilator-associated pneumonia in a resource-limited setting: a retrospective cohort study of clinical outcomes
  
JOURNAL=Journal of Pharmacy & Pharmaceutical Sciences
  
VOLUME=Volume 29 - 2026
  
YEAR=2026
  
URL=https://www.frontierspartnerships.org/journals/journal-of-pharmacy-pharmaceutical-sciences/articles/10.3389/jpps.2026.17336
  
DOI=10.3389/jpps.2026.17336
  
ISSN=1482-1826
  
ABSTRACT=BackgroundHospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are major causes of in-hospital mortality and antimicrobial resistance (AMR), particularly in low- and middle-income countries (LMICs). Carbapenems are commonly used due to their broad-spectrum activity; however, their efficacy in real-world clinical practices comparing carbapenem with non-carbapenem regimens in these settings is limited.ObjectivesTo compare clinical outcomes between patients receiving carbapenem-based and non-carbapenem therapy for HAP and VAP at a tertiary care hospital in Pakistan.MethodsThis retrospective cohort study included 93 adult patients (HAP: n = 62, VAP: n = 31) over the period of 1 year. Demographics, comorbidities, microbial isolates, treatment regimen, and clinical outcomes were analyzed using descriptive statistics, chi-square tests, and risk ratio calculations with 95% confidence interval. Multivariable logistic regression was planned to adjust for confounders but was not feasible due to missing severity score and biomarker data.ResultsHAP was more common in females (63%), while VAP showed a male predominance (52%). The most common pathogens were Acinetobacter spp. (HAP: 11.3%; VAP: 19.4%) and Pseudomonas aeruginosa (HAP: 11.3%; VAP: 16.1%). The most prevalent comorbidity in HAP was diabetes mellitus (38.7%). Carbapenem-based therapy (meropenem) was used in 65.6% of cases and the most frequently prescribed non-carbapenem agents were piperacillin-tazobactam, ceftazidime, and colistin. No significant difference in mortality was observed between carbapenem and non-carbapenem therapy in HAP (31.6% vs. 29.2%; RR 1.08, 95% CI 0.50–2.36, p = 0.840) or VAP (65.2% vs. 50.0%; RR 1.30, 95% CI 0.61–2.77, p = 0.440). VAP was associated with significantly higher crude mortality than HAP (61.3% vs. 30.6%; p = 0.005). Crude mortality rates appeared highest among patients in the Acinetobacter baumannii group (70.4%) and Pseudomonas aeruginosa group (31.3%), though treatment group difference were not statistically significant.ConclusionIn this single-center retrospective cohort, no statistically significant association between carbapenem-based therapy and all-cause in-hospital mortality was detected in HAP or VAP. Crude mortality appeared highest among patients with Acinetobacter and Pseudomonas isolates. However, wide confidence intervals, treatment-selection bias, and unadjusted analyses preclude definitive conclusions. These findings should be considered hypothesis-generating, requiring confirmation in adequately powered, larger prospective studies.