Carbapenems are broad-spectrum antibiotics indicated for severe infections caused by multidrug-resistant bacteria, especially in patients admitted to intensive care units (ICUs). Despite their crucial role, excessive use of these drugs contributes to the emergence of resistant strains, such as carbapenemase-producing Enterobacterales. In the Brazilian context, understanding the pattern of use and costs associated with carbapenems can inform rationalization policies. This study evaluates the trend of hospital use of carbapenems in the SUS, its economic impact, and regional disparities.

Ecological, retrospective study with analysis of secondary data obtained from the SUS Hospital Information System (SIH/SUS) and the Health Prices Database (BPS). Admissions with records of administration of antibacterials classified as carbapenems (ATC J01DH) in patients admitted to ICUs between 2015 and 2023 were included. The variables analyzed included number of administrations, average cost per admission, and regional distribution. Data were analyzed by time series and by geographic region.

During the period from 2015 to 2023, 89,374 administrations of carbapenems were identified in patients admitted to ICUs in the SUS. The Southeast region accounted for 46 percent of records, followed by the South (24 percent), Northeast (16 percent), Midwest (9 percent), and North (5 percent). The most used antibiotic was meropenem (71 percent), followed by imipenem/cilastatin (19 percent) and ertapenem (10 percent). The average cost per admission with carbapenems was R$ 7,800, significantly higher than the overall average for ICU admissions without the use of these drugs (R$ 4,300). There was a 42 percent increase in consumption between 2015 and 2021, with a slight decrease in 2022 and 2023.

The use of carbapenems in Brazilian ICUs remains high, reflecting case severity and bacterial resistance, with emphasis on meropenem. Regional inequalities highlight differences in access and infrastructure. Despite recent signs of stabilization, it is urgent to strengthen rational use strategies, focusing on surveillance, microbiological diagnosis, and training within the SUS.