PRS10 - Estimation of the Number of Cases of Nosocomial Pneumonia in Adults Caused by Gram-Positive Bacteria in Public Hospitals in Mexico

Abstract

To estimate the number of cases of nosocomial pneumonia (NP) in adults caused by Gram-positive bacteria (GPB) in public hospitals in Mexico. To estimate the number of hospital discharges for each public institution in ≥ 18 years, databases from the National Health Information System (SINAIS) were consulted. We apply the nosocomial infection (NI) rate (5.97 cases per 100 discharges) issued by Instituto Mexicano del Seguro Social (IMSS) during the period 2011-2012. Through a systematic literature review and critical reading of studies developed in the Mexican setting (using the Critical Appraisal Skills Programme guidelines) we assessed the type of infection and determined the proportion of cases in which microbiological culture was obtained, as well as the proportion giving positive isolates; subsequently, etiologic agent was disaggregated according to their Gram staining characteristics. In the year 2011 there were 5,517,139 discharges from public hospitals, applying a rate of 5.97 NI cases/100 discharges, resulted in 329,373 NI cases (16.9% under 18 years and 83.1% in adults). The NP represented 33.2% of NI (90,882 cases), of these, only in 63% of cases a microbiological culture was obtained (57,256) and pathogens were isolated in 87.0% of microbiological cultures (49,813), among these, GPB we identified in 30.4% . According to our estimates the number of cases of adult NP caused by GPB is 15,135 and the pathogens reported were Staphylococcus aureus (74.3%), Streptococcus pneumoniae (15.6%), Enterococcus spp. (6.3%) and others (3.8%). In spite of high heterogeneity found in NI reports (which may decrease the quality of the information recorded), the local data reported in this study can help clinicians in the choice of first line antibiotics in order diminish the probability of unsuccessful treatment and additionally to reduce the emergence of resistant organisms, which could cause negative economic impact in the health care institutions.