Factors associated with nosocomial pneumonia mortalityin a public hospital in Peru

Objective: To determine factors associated with mortality in patients with nosocomial pneumonia at the Hospital Dos de Mayo, Lima-Peru between January 2006 to December 2010. Methods: Retrospective cohort study, patients eligible for the study were over 18 years of age, sick time record and known exit condition (discharge or deceased). For survival analysis we used the Kaplan-Meier and Cox regression. Results: We identified 658 patients diagnosed with nosocomial pneumonia, and the causative agent was identified in 173 (26,75%). The mean age was 58,4ñ19,6 years, 238 patientes died (36,2%); median survival time was 16 days. Male sex presented HR=1,15, 95%CI 0.89-1.49. At 10 and 20 days the survival rate was 70% and 40% in those with Klebsiella, 85% and 75% in those with Pseudomonas, and 70% and 65% in those with Staphylococcus aureus. In the multivariate analysis, we identified exposure to mechanical ventilation (HR 1,98; 95%CI 1,35 to 2,89), use of a nasogastric tube (HR 1,33; 95%CI 1,01 to 1,76) and age over 65 years (HR 1,96; (95%CI 1,51 to 2,55) as factors associated with mortality, while resistance to ceftazidime and amikacin present HR 1,45 (95%CI 0,74 -2,84). Conclusions: In nosocomial pneumonia, the exposure to mechanical ventilation, nasogastric tube and age over 65 years, are associated with lower survival. This suggests the introduction of preventive measures in this risk group.