INCIDENCE OF NOSOCOMIAL PNEUMONIA IN A MEDICAL INTENSIVE-CARE UNIT AND GENERAL MEDICAL WARD PATIENTS IN A PUBLIC HOSPITAL IN BOMBAY, INDIA

We prospectively studied the incidence of hospital-acquired pneumonia in 1886 consecutive admissions to an 1800 bed hospital in Bombay; 991 of them to general medical wards and 895 to a 17-bed medical intensive care unit (ICU). The average bed occupancy in the general wards was 5 6 patients in a ward with 40 beds. Staffing in the general ward was tw o nurses for 56 patients, and in the ICU three nurses for 17 beds. One hundred and sixty-eight patients developed nosocomial pneumonia: 18 ( 1.8%) in general wards and 150 (16.7%) in the ICU. Common isolates inc luded Pseudomonas spp (44%) and Klebsiella spp (34%). The most frequen tly used antibiotics were cefotaxime (34%), amikacin (25%), gentamicin (23%) and ofloxacin (13%). Crude mortality in general ward patients w as 88.9 vs 14.6% in patients without pneumonia. The corresponding figu res for ICU patients were 67.4 vs 37.1%; 40% of the crude mortality in ICU patients with pneumonia was attributable to the infection. Infect ed patients stayed an additional 5.8 days in the ICU and 6.7 days in t he general ward. Costs of additional stay and antibiotics accounted fo r 18.6% of the ICU budget. The incidence of nosocomial pneumonia was l ower than expected, despite occupancy exceeding bed capacity, low nurs e:patient ratios, and extensive reuse of disposable respiratory therap y equipment. Nevertheless, nosocomial pneumonia imposes a significant financial burden on the already scarce resources available for intensi ve care in developing countries like India.