Prevalence of Carbapenem-Resistant Gram-Negative Bacilli from Intensive Care Units from Latin America and the Caribbean: A Systematic Review and Meta-Analysis.

Background

Carbapenem-resistant Gram-negative bacilli (CR-GNB) represent a critical threat to patients in intensive care units (ICUs), where limited therapeutic options contribute to elevated mortality. In Latin America and the Caribbean (LAC), the epidemiological burden of CR-GNB remains insufficiently characterized due to fragmented surveillance systems. This systematic review aimed to synthesize pooled prevalence estimates of CR-GNB among Gram-negative isolates recovered from ICUs across LAC countries.

Methods

This systematic review was prospectively registered with PROSPERO (CRD420251177826), followed PRISMA 2020 guidelines and the JBI Manual for prevalence reviews. We searched PubMed, Scopus, LILACS, and SciELO from January 2015 to October 2025 without language restrictions. Observational studies reporting phenotypic carbapenem resistance data from ICUs in LAC countries were eligible. Two reviewers independently screened studies and extracted data. A two-level multilevel generalized linear mixed model (GLMM) with logit transformation was employed using a random-effects approach. Risk of bias was assessed using the JBI critical appraisal checklist.

Results

Of 25 eligible studies spanning eight countries, 12 contributed 49 observations to quantitative synthesis. Overall pooled prevalence of CR-GNB was 28.88% (95% CI: 17.32-44.05%), with considerable heterogeneity (I2 = 95.24%). Species-specific prevalence was highest for Acinetobacter baumannii (72.58%), followed by Klebsiella pneumoniae (37.48%) and Pseudomonas aeruginosa (29.93%). Regional stratification revealed higher prevalence in South America (31.81%) compared to North America (22.65%) and the Caribbean (11.63%).

Conclusions

Nearly one-third of Gram-negative isolates from LAC ICUs exhibit carbapenem resistance, with A. baumannii predominating. Substantial inter-study heterogeneity underscores the need for standardized regional surveillance networks and coordinated antimicrobial stewardship initiatives.