Discussion
CoNS, BSI, ICU-associated, bacteremia, Decolonisation, gram-negative
This is a post-hoc before-after analysis of the first comparative multi-center cRCT that examined antiseptic bathing with chlorhexidine and octenidine for CLABSI prevention in ICUs. In the post-hoc analysis comparing baseline and intervention periods (before-after), chlorhexidine-impregnated cloths significantly reduced ICU-associated CLABSI by about 40%. Decolonisation with chlorhexidine had no effect on CLABSI caused by gram-negative pathogens, but prevented CLABSI caused by gram-positive bacteria, mainly CoNS. In contrast, octenidine wash mitts did not show a preventive effect on CLABSI, neither caused by gram-positive nor gram-negative bacteria. At the same time CLABSI rates remained stable in the control group over the entire observation period.Our post-hoc analysis confirmed findings of previous studies that showed a preventive effect of chlorhexidine-impregnated cloths on CLABSI rates in ICU patients [Octenidine wash mitts did not reduce CLABSI of ICU patients in our study. Thus, we could not confirm the promising results of previous single-center observational trials [The reduction of CLABSI in the chlorhexidine group could mainly be attributed to CLABSI with CoNS. At the same time, the increase of CLABSI in the octenidine group was also mainly due to CLABSI with gram-positive bacteria including CoNS. Even though CoNS are considered pathogens of low virulence, catheter-related BSI or bacteremia with CoNS have been associated with severe clinical outcomes including increased duration of hospitalization, therapy related costs and morbidity [Tolerability of chlorhexidine-impregnated cloths and octenidine wash mitts by patients was high and has been reported in detail elsewhere [