Factors Associated With In‐Hospital Mortality and Length of Stay Among Hospitalised Patients Receiving Carbapenem Therapy: A Retrospective Cohort Study
Abdullah Faiz Zaihan, Dhivyaa K. Ganesan, Chia Siang KowBackground
Patients receiving carbapenems are clinically heterogeneous and have severe infections and multiple comorbidities. Evidence on factors associated with mortality and length of stay (LOS) in this treatment‐defined population remains limited.
Methods
This retrospective cohort study included adult hospital episodes involving at least one carbapenem dose at Hospital Shah Alam during 2025. Firth penalised logistic regression was used for in‐hospital mortality, and median regression with 2000 bootstrap resamples was used for right‐skewed LOS. Covariates were selected a priori. Carbapenem continuation beyond 72 h was treated as a postbaseline characteristic and was not included in outcome models.
Results
Among 112 eligible episodes involving 107 patients, 38 deaths occurred (33.9%); median LOS was 19.0 days (IQR: 10.8–28.0). Older age (adjusted OR: 1.41 per 10 years, 95% CI: 1.07–1.92) and definitive indication at carbapenem initiation (adjusted OR: 0.28, 95% CI: 0.10–0.70) were associated with in‐hospital mortality. Hospital‐acquired infection was associated with a longer adjusted median LOS (median difference 8.63 days, 95% bootstrap CI: 0.50–14.44). Definitive indication was not clearly associated with LOS after adjustment (median difference −5.54 days, 95% bootstrap CI: −12.00–4.62).
Conclusions
Older age and definitive indication at carbapenem initiation were associated with in‐hospital mortality, while hospital‐acquired infection was associated with longer median LOS. The treatment‐indication association should not be interpreted causally because residual confounding, particularly by acute illness severity and indication, remains likely.