Safety of discontinuing contact precautions in patients with multidrug-resistant bacterial infection or colonization

Lack of standardized criteria for discontinuing contact precautions (CP) in patients colonized or infected with multidrug-resistant bacteria (MDRB) can prolong isolation and strain healthcare resources. This retrospective cohort study aimed to assess the safety of a protocol-guided CP discontinuation strategy and identify risk factors for MDRB reacquisition. The study evaluated 88 adult patients under CP who met an institutional protocol for CP discontinuation between 2018 and 2023. The protocol required: no active infection; no antibiotic use in the preceding seven days; no drains or open wounds; no diarrhea; a negative culture from the initial site of MDRB identification; and a subsequent confirmatory negative screening (culture and/or PCR). Patients were followed for one year after CP discontinuation to assess MDRB reacquisition, defined as a new positive specimen for the same species. Potential risk factors for reacquisition were analyzed using multivariable Cox regression. At the one-year follow-up, MDRB reacquisition occurred in 17% (15/88) of patients. The reacquired pathogens included carbapenem-resistant Enterobacterales (9/50), methicillin-resistant Staphylococcus aureus (6/30), and vancomycin-resistant Enterococcus spp. (0/8). Independent risk factors for reacquisition were chronic obstructive pulmonary disease (HR 5.76, 95% CI 1.34-24.81), shorter duration of isolation (HR 0.98 per day, 95% CI 0.97-0.99), frequent hospitalizations (HR 1.75 per admission, 95% CI 1.07-2.88), and central venous catheterization (HR 13.04, 95% CI 2.63-64.69). Protocol-guided CP discontinuation was associated with a low rate of MDRB reacquisition and appears safe in appropriately selected patients. This approach may reduce unnecessary isolation in eligible patients, though high-risk individuals require closer monitoring.