Carbapenem-based empiric regimens were associated with lower mortality rates compared with non-carbapenems, largely driven by trials of ventilator-associated pneumonia (VAP).

The mortality effect was not observed in trials with high disease severity and was not associated with Pseudomonas.

The mortality difference was observed mainly in studies that used ceftazidime as control.

There was a trend toward increasing resistance associated with carbapenems.

Of 9,140 references, 20 trials enrolling 5,489 patients met inclusion criteria.

For mortality, carbapenem use had a risk ratio (RR) of 0.84.

Stratified according to VAP proportion, RRs were 0.95, 0.78, and 0.81, respectively.

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