A groundbreaking international study has uncovered a significant correlation between the rise of antibiotic-resistant bacteria and the universal disinfection procedures employed in intensive care units (ICUs). Conducted by researchers at the University of Bologna and published in The Lancet Microbe, the study urges a reassessment of healthcare practices related to the pervasive employment of disinfectants. Marco Oggioni, a professor at the Department of Pharmacy and Biotechnology at the University of Bologna and co-author of the study, warned of the inadvertent ramifications of universal decolonization in a time when antibiotic resistance is burgeoning into a global threat.
Typically, on admission to an ICU, patients undergo a preventive procedure known as universal decolonization. This process involves disinfecting the patient’s entire body with chlorhexidine, a widely applied antiseptic also used to sanitize medical equipment and hospital surfaces. In addition to this, patients receive a nasal treatment with another disinfectant, mupirocin. Introduced in the 1990s, universal decolonization has been successful in restraining the spread of MRSA (Methicillin-Resistant Staphylococcus aureus), a bacteria resistant to several antibiotics.
However, there has been inconsistency between the MRSA infection rates in different countries. While the implementation of universal decolonization has brought down MRSA rates from 30-40% to under 5% in countries like Scotland, Italy continues to struggle with a high 26% MRSA prevalence.
During the research, the team focused on two Scottish hospitals that use contrasting approaches: a universal decolonization policy versus a targeted approach where only patients who test positive for MRSA are decolonized. The findings shed light on higher infection rates by the MRSE (Methicillin-Resistant Staphylococcus epidermidis) superbug in the hospitals following universal decolonization.
The study elucidates that indiscriminate use of disinfectants in ICUs for universal decolonization, instead of enhancing infection control, could stimulate a surge in MRSE infections. These findings give a compelling rationale to reassess the benefits and risks of disinfection procedures, especially in regions with low MRSA prevalence.
Nevertheless, places with high MRSA transmission risk, like Italy, require the deployment of both targeted and universal decolonization until the prevalence can be controlled.
In light of these findings, the authors call for an overhaul of current practices and demand the formulation of new standardized guidelines. These should be focused on discerning the most efficacious decolonization treatments while concurrently considering their impact on antibiotic resistance.