PIN8 - Estimation of the Number of Cases of Nosocomial Skin and Soft Tissue Infection in Adults Caused by Gram-Positive Bacteria in Public Hospitals in Mexico

Abstract

To estimate the number of cases of nosocomial skin and soft tissue infection (SSTIs) in adults caused by Gram-positive bacteria (GPB) in public hospitals in Mexico. The total number of hospital discharges in patients ≥18 years were extracted from databases of the National Health Information System. A rate of 5.97 cases of nosocomial infection (NI) per 100 discharges (issued by Instituto Mexicano del Seguro Social between 2011 and 2012) was applied. Through a systematic literature review and critical reading of studies developed under the Mexican setting (using the Critical Appraisal Skills Programme guidelines), we assessed the type of infection and determined the proportions of: microbiological culture obtained and microbiological culture giving positive isolates. In the last stage, microorganisms were classified according to their Gram staining characteristics. In the year 2011 there were 5,517,139 discharges from public hospital, inferring 329,373 cases of NI rate (16.9% under 18 years and 83.1% in adults). We estimated that SSTIs represents 33.2% of NI (42,430 cases), of these, a microbiological culture was obtained only in 63.0% of the cases (26,731) and pathogen were isolated in 87.0% of microbiological cultures (23,256), among these, GPB was identified in 44.2%. According to our estimates a conservative number of cases of nosocomial SSTis in adults caused by GPB in 2011 was 10,279 and the pathogens reported were Staphylococcus aureus (71.1%), Enterococcus spp (14.2%), and others (14.6%). Although we found high heterogeneity in NI reports which may decrease the quality of the estimates presented in this research, in our opinion these results could help clinicians in the choice of initial antibiotics in order to reduce the probability of failure due emergence of resistant organisms.