ICU Disinfectant Procedure Raises Concerns Over Antibiotic Resistance

European researchers are urging a reconsideration of healthcare protocols following findings that a disinfectant procedure commonly used in intensive care units (ICUs) could inadvertently elevate the risk of antibiotic-resistant infections. This call to action stems from a study published in The Lancet Microbe on June 23, 2025, which examined the implications of 'universal decolonization' protocols employed in various healthcare settings across Europe.

Universal decolonization involves a comprehensive disinfection protocol where patients are treated with chlorhexidine, a widely utilized antiseptic, and mupirocin, an antibiotic ointment, upon their admission to ICU. Marco Oggioni, a professor at the University of Bologna and co-author of the study, emphasized the necessity for a critical review of current practices: "Our research highlights the unintended consequences of universal decolonization in a global context where antibiotic resistance is an increasing threat. Coordinated efforts to prevent antibiotic-resistant infections are crucial, but they must not prevent us from critically re-evaluating the tools we use to achieve these goals."

The study analyzed data from two Scottish hospitals over a 13-year span, contrasting the infection rates of patients in facilities that adopted universal decolonization against those that implemented a more targeted approach. Researchers found a notable increase in infections caused by methicillin-resistant Staphylococcus epidermidis (MRSE), a less well-known but increasingly prevalent superbug, in hospitals practicing universal decolonization. Professor Karolin Hijazi from the University of Aberdeen, who coordinated the research, stated, "The excessive use of disinfectants in universal decolonization may not improve infection control and instead leads to a rise in MRSE infections."

The findings raise significant questions about the efficacy of universal decolonization, particularly in regions like Scotland, where MRSA infection rates are relatively low. According to Oggioni, infection control measures must be tailored to the epidemiological context: "In Italy, however, MRSA infection risk remains high despite a downward trend, which means both targeted and universal decolonization are still necessary. We’ll need to reduce MRSA prevalence in Italy before we can reassess the risks and benefits of these intervention procedures."

Given the rising rates of antibiotic resistance globally, researchers are advocating for the establishment of standardized guidelines that weigh the benefits of infection control against the potential consequences for antibiotic resistance. The implications of this study extend beyond Scotland; as antibiotic resistance continues to pose a significant public health threat worldwide, the need for evidence-based healthcare protocols becomes increasingly urgent.

The research entitled 'Universal versus targeted chlorhexidine and mupirocin decolonisation and clinical and molecular epidemiology of Staphylococcus epidermidis bloodstream infections in patients in intensive care in Scotland, UK: a controlled time-series and longitudinal genotypic study' is available open access in The Lancet Microbe at doi.org/10.1016/j.lanmic.2025.101118.