OBJECTIVES To estimate direct medical costs of management of nosocomial pneumonia (NP) and ventilator-associated nosocomial pneumonia (VAP) in General Hospital (GH) of Raza National Medical Center METHODS Data from nosocomial pneumonia patients who diagnosed according to Mexican Official Standard Nom-026-SSA2-1998 and received medical assistance in GH between 2006–08 were include in the study. The clinical response was used to assess clinical status (fail or successful in the first treatment). Costs were estimated from the hospital perspective using a bottom-up approach, and only direct medical costs were estimated (hospitalization, treatment, laboratory tests, specialist visit). Clinical data and resource utilization were obtained from individual clinical. The unitary costs used are those officially published by IMSS. A 5% discount rate was used, and costs were adjusted as to 2008. Results are shown as mean standard (SD) and pesos mexicans. Generalized Linear Model analysis was applied. Sensitivity analyses included variation of the main variables RESULTS 113 patients were included, 70 with NP and 43 patients with VAP. Male 62%, age 57 ±18 years, patients with NP and VAP due to Pseudomonas aeruginosa were 34%. Mortality were 24%. Patients with VAP who fail first treatment were 68% vs NP 53% (p=0.03). More resources were utilized for VAP patients compared to NP in length of stay in days in intensive care unit 8.64 vs 3.7 days respectively (p<0.0001). Average VAP costs per fail patient in first treatment were higher than successful patients MXN$279,619.6 vs $190,908.7(p<0.0001). In NN happened same situation $172,411.2 vs $132,306.4 (p=0.001). 93% and 96% of total costs were due to hospitalization in patients with NP and VAP, respectively CONCLUSIONS: Strategies should be looked for to obtain better results since the first scheme of treatment with this type of patients to avoid incremental cost of a fail patient.