ICD-9-CM Coding for Multidrug Resistant Infection Correlates Poorly With Microbiologically Confirmed Multidrug Resistant Infection

analysis.Infection density rate (IDR), conditional maximum likelihood estimate (CMLE) of rate ratio (RR), 95% confidence intervals (CI), and P values were calculated.The Fisher exact test was used to compare IDRs among years.P < .05 was considered statistically significant.The IDR did not increase for ESBL-EC after cessation of contact precautions in our hospital.Also, no change was observed for IDR for ESBL-producing K. pneumoniae or for CR K. pneumoniae between 2015 and 2016.An increase in CR E. coli bacteremia at the Oncology Hospital was observed, but it was not statistically significant (Table 1).A recent Swiss study showed the safety of cessation of contact precautions for ESBL-EC in a setting where compliance with standard infection control precautions and hand hygiene is high.5 Compliance with infection control precaution is highly variable in our hospital.The rate of compliance with hand hygiene before patient contact is nearly 90% in the oncology ICU and BMT units; however, it was 30%-60% in the surgical ICUs.Nevertheless, we did not observe an increase in the rate of ESBL-EC bacteremia.This study has some limitations.First, we did not compare the types of ESBL-EC infection other than bacteremia between 2015 and 2016, but no clusters of ESBL-EC infections were detected in any of the wards during surveillance activities.Bacteremia surveillance is the only type of surveillance that is performed hospital-wide, so we decided to compare the bacteremia rates.Also, we did not have access the molecular epidemiology of ESBL-EC because it is very difficult to analyze the genetic relatedness of ESBL-EC in daily practice for infection control purposes.Despite all limitations, our study showed that, in a middle outcome country where compliance to infection control precaution is highly variable, cessation of contact precautions for ESBL-EC did not result in a negative outcome.However, infection control teams practicing in crowded hospitals under high workload with insufficient staff should be cautious because ESBL-EC outbreaks are common.