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Disease Prevention and Control / Communicable Diseases / Antimicrobial Resistance

Cost of Hospital Infection in Nine Countries of Latin America

(Roxane Salvatierra-González, ed.)

Costo de la infección nosocomial en 9 países de América Latina
E-Book (184 pp, Spanish only)

To respond to the threat to public health posed by the growing resistance of certain infectious agents to antimicrobial drugs, the PAHO Communicable Disease Unit has allocated significant resources since the mid-1990s in the form of technical cooperation to the countries of the Region, in an effort to strengthen their epidemiological infrastructure for microbiological detection. The objective of these initiatives has been to develop methods for containing the spread of infections resistant to antimicrobial drugs and to follow up on the problem epidemiologically. It was also considered indispensable to observe the predominant trends of antimicrobial resistance among the microorganisms causing the infections, both in the community and in hospitals. To that end, programs have been prepared and implemented for both short-term and long-term training, and standardized procedures have been designed and applied to improve quality-assurances and performance-evaluation processes with regard to sensitivity tests for pathogens under surveillance that are resistant to antibiotics. These training programs involved participation by personnel from each country from both their National Reference Laboratory and Sentinel Sites of their National Laboratory Network.

Hospital-acquired infections are a major cause of morbidity and mortality among people who are hospitalized; thus, they constitute a significant social and economic burden both for patients and for the health system. Many of these infections are caused by microorganisms resistant to several antimicrobial drugs. Hence, for the purpose of complementing the information generated by the aforementioned epidemiological follow-up, and in order to develop local plans to contain hospital infections, PAHO summoned an expert working group to prepare a research protocol that could be applied in various hospitals of the Region. This protocol would be used to determine the costs of hospital-acquired infections, including those related to prescribing and taking antimicrobial medications.

The articles presented in this book are the result of the application of said protocol (Annex 1) in hospitals from nine countries of the Region (Argentina, Bolivia, Chile, Ecuador, El Salvador, Guatemala, Nicaragua, Paraguay and Peru).

The costs of hospital infections in this particular sample of hospitals of the Region, as quantified by the protocol, varied depending—among other factors—on the incidence of the nosocomial infections selected for the study and on local availability and cost of care. Nevertheless, all the studies demonstrated that preventing hospital-acquired infection results in an improvement of medical care and a significant cost reduction. For example, in one Guatemalan hospital, a case of nosocomial pneumonia associated with mechanical ventilation cost more than US$ 1,758 per case, or 2.5 times the cost of care for a patient who did not catch that infection. If this individual cost is multiplied by the 116 cases of the same infection reported during the year when the study was carried out, the cost just for this single type of infection comes to more than US$ 203,928—approximately 160 times the minimum yearly wage in Guatemala in 2002. Any investment made to prevent hospital infections should reduce these costs, in addition to generating benefits for both patient health and well-being as well as diminishing the economic impact of such infections both for the individual and for society.

To supplement surveillance activities related to resistance to antibiotics, and as a way of helping reduce its social, public-health, and economic impact, PAHO has prepared and printed a Modelo de guía clínica y formulario para el tratamiento de las enfermedades infecciosas (Model for a Clinical Guide and Form for Treating Infectious Diseases, available in Spanish only via the link). This Guide is available to the countries to enable them to adapt their current national and institutional practice to lead to a more rational use of antibiotics.

We hope that the information presented in this book will serve as stimulus to generate action and effective measures to contain the spread of antimicrobial resistance and diminish the human and economic costs of hospital infections.