Frost SA, Alogso M-C, Metcalfe L, Lynch JM, Hunt L, Sanghavi R, Alexandrou E, Hillman KM (2016) Chlorhexidine bathing and health care-associated infections among adult intensive care patients: a systematic review and meta-analysis. Crit Care 20:1–6

Google Scholar 

Lu S, Zhang W, Li X, Xian J, Hu Y, Zhou Y (2022) Skin bacterial richness and diversity in intensive care unit patients with severe pneumonia. Int J Infect Dis 121:75–84

CAS  PubMed  Google Scholar 

Cassir N, Papazian L, Fournier P-E, Raoult D, La Scola B (2015) Insights into bacterial colonization of intensive care patients’ skin: the effect of chlorhexidine daily bathing. Eur J Clin Microbiol Infect Dis 34:999–1004

CAS  PubMed  Google Scholar 

Vincent JL, Sakr Y, Ranieri VM (2003) Epidemiology and outcome of acute respiratory failure in intensive care unit patients. Crit Care Med 31:S296–S299

CAS  PubMed  Google Scholar 

Klassert TE, Zubiria-Barrera C, Denkel L, Neubert R, Schneegans A, Kulle A, Vester A, Bloos F, Schulze C, Epstude J (2024) Skin dysbiosis and loss of microbiome site specificity in critically ill patients. Microbiol Spectr 12:e03078-e3123

PubMed  PubMed Central  Google Scholar 

Byrd Allyson L, Yasmine B, Segre Julia A (2018) The human skin microbiome. Nat Rev Microbiol 16:143–155

CAS  PubMed  Google Scholar 

Denkel LA, Schwab F, Clausmeyer J, Behnke M, Golembus J, Wolke S, Gastmeier P, Geffers C (2023) Central-line associated bloodstream infections in intensive care units before and after implementation of daily antiseptic bathing with chlorhexidine or octenidine: a post-hoc analysis of a cluster-randomised controlled trial. Antimicrob Resist Infect Control 12:55

PubMed  PubMed Central  Google Scholar 

Gastmeier P, Kämpf KP, Behnke M, Geffers C, Schwab F (2016) An observational study of the universal use of octenidine to decrease nosocomial bloodstream infections and MDR organisms. J Antimicrob Chemother 71:2569–2576

CAS  PubMed  Google Scholar 

Messler S, Klare I, Wappler F, Werner G, Ligges U, Sakka SG, Mattner F (2019) Reduction of nosocomial bloodstream infections and nosocomial vancomycin-resistant Enterococcus faecium on an intensive care unit after introduction of antiseptic octenidine-based bathing. J Hosp Infect 101:264–271

CAS  PubMed  Google Scholar 

Denkel LA, Schwab F, Clausmeyer J, Behnke M, Golembus J, Wolke S, Gastmeier P, Geffers C (2022) Effect of antiseptic bathing with chlorhexidine or octenidine on central line–associated bloodstream infections in intensive care patients: a cluster-randomized controlled trial. Clin Microbiol Infect 28:825–831

CAS  PubMed  Google Scholar 

Htun HL, Hon PY, Holden MT, Ang B, Chow A (2019) Chlorhexidine and octenidine use, carriage of qac genes, and reduced antiseptic susceptibility in methicillin-resistant Staphylococcus aureus isolates from a healthcare network. Clin Microbiol Infect 25:1154e1-1154e7

Google Scholar 

Kampf G (2016) Acquired resistance to chlorhexidine–is it time to establish an ‘antiseptic stewardship’initiative? J Hosp Infect 94:213–227

CAS  PubMed  Google Scholar 

Suwantarat N, Carroll KC, Tekle T, Ross T, Maragakis LL, Cosgrove SE, Milstone AM (2014) High prevalence of reduced chlorhexidine susceptibility in organisms causing central line–associated bloodstream infections. Infect Control Hosp Epidemiol 35:1183–1186

PubMed  Google Scholar 

Denkel LA, Kramer TS, Schwab F, Golembus J, Wolke S, Gastmeier P, Geffers C (2022) Chlorhexidine and octenidine susceptibility of bacterial isolates from clinical samples in a three-armed cluster randomised decolonisation trial. PLoS ONE 17:e0278569

CAS  PubMed  PubMed Central  Google Scholar 

Babiker A, Lutgring JD, Fridkin S, Hayden MK (2021) Assessing the potential for unintended microbial consequences of routine chlorhexidine bathing for prevention of healthcare-associated infections. Clin Infect Dis 72:891–898

CAS  PubMed  Google Scholar 

Schröder C, Schwab F, Behnke M, Breier AC, Maechler F, Piening B, Dettenkofer M, Geffers C, Gastmeier P (2015) Epidemiology of healthcare associated infections in Germany: nearly 20 years of surveillance. Int J Med Microbiol 305:799–806

PubMed  Google Scholar 

Grice EA, Segre JA (2011) The skin microbiome. Nat Rev Microbiol 9:244–253

CAS  PubMed  PubMed Central  Google Scholar 

Klassert TE, Leistner R, Zubiria-Barrera C, Stock M, López M, Neubert R, Driesch D, Gastmeier P, Slevogt H (2021) Bacterial colonization dynamics and antibiotic resistance gene dissemination in the hospital environment after first patient occupancy: a longitudinal metagenetic study. Microbiome 9:1–17

Google Scholar 

Klassert TE, Zubiria-Barrera C, Neubert R, Stock M, Schneegans A, López M, Driesch D, Zakonsky G, Gastmeier P, Slevogt H (2022) Comparative analysis of surface sanitization protocols on the bacterial community structures in the hospital environment. Clin Microbiol Infect 28:1105

CAS  PubMed  Google Scholar 

Caporaso JG, Lauber CL, Walters WA, Berg-Lyons D, Huntley J, Fierer N, Owens SM, Betley J, Fraser L, Bauer M (2012) Ultra-high-throughput microbial community analysis on the Illumina HiSeq and MiSeq platforms. ISME J 6:1621–1624

CAS  PubMed  PubMed Central  Google Scholar 

Walters W, Hyde ER, Berg-Lyons D, Ackermann G, Humphrey G, Parada A, Gilbert JA, Jansson JK, Caporaso JG, Fuhrman JA (2016) Improved bacterial 16S rRNA gene (V4 and V4–5) and fungal internal transcribed spacer marker gene primers for microbial community surveys. Msystems 1:e00009-15

PubMed  Google Scholar 

Bolyen E, Rideout JR, Dillon MR, Bokulich NA, Abnet CC, Al-Ghalith GA, Alexander H, Alm EJ, Arumugam M, Asnicar F (2019) Reproducible, interactive, scalable and extensible microbiome data science using QIIME 2. Nat Biotechnol 37:852–857

CAS  PubMed  PubMed Central  Google Scholar 

Friedman J, Alm EJ (2012) Inferring correlation networks from genomic survey data

European Centre for Disease Prevention and Control. Antimicrobial resistance in the EU/EEA (EARS-Net)– Annual epidemiological report for 2019. Stockholm: ECDC; 2020. Available from: https://www.ecdc.europa.eu/en/publications-data/surveillance-antimicrobial-resistance-europe-2019

Mandal S, Van Treuren W, White RA, Eggesbø M, Knight R, Peddada SD (2015) Analysis of composition of microbiomes: a novel method for studying microbial composition. Microb Ecol Health Dis 26:27663

PubMed  Google Scholar 

Wiemken TL, Ericsson AC (2021) Chlorhexidine gluconate does not result in epidermal microbiota dysbiosis in healthy adults. Am J Infect Control 49:769–774

CAS  PubMed  Google Scholar 

SanMiguel AJ, Meisel JS, Horwinski J, Zheng Q, Bradley CW, Grice EA (2018) Antiseptic agents elicit short-term, personalized, and body site–specific shifts in resident skin bacterial communities. J Investig Dermatol 138:2234–2243

CAS  PubMed  Google Scholar 

Burnham C-AD, Hogan PG, Wallace MA, Deych E, Shannon W, Warren DK, Fritz SA (2016) Topical decolonization does not eradicate the skin microbiota of community-dwelling or hospitalized adults. Antimicrob Agents Chemother 60:7303–7312

CAS  PubMed  PubMed Central  Google Scholar 

Two AM, Nakatsuji T, Kotol PF, Arvanitidou E, Du-Thumm L, Hata TR, Gallo RL (2016) The cutaneous microbiome and aspects of skin antimicrobial defense system resist acute treatment with topical skin cleansers. J Invest Dermatol 136:1950–1954

CAS  PubMed  Google Scholar 

Acosta EM, Little KA, Bratton BP, Lopez JG, Mao X, Payne AS, Donia M, Devenport D, Gitai Z (2023) Bacterial DNA on the skin surface overrepresents the viable skin microbiome. Elife 12:87192

Google Scholar 

Koburger T, Hübner NO, Braun M, Siebert J, Kramer A (2010) Standardized comparison of antiseptic efficacy of triclosan, PVP-iodine, octenidine dihydrochloride, polyhexanide and chlorhexidine digluconate. J Antimicrob Chemother 65:1712–1719

CAS  PubMed  Google Scholar 

Mougeot J-LC, Beckman MF, Bahrani Mougeot F, Horton JM (2022) Cutaneous microbiome profiles following chlorhexidine treatment in a 72-hour daily follow-up paired design: a pilot study. Microbiol Spectr 10:e01753-e1821

PubMed  PubMed Central  Google Scholar 

Flores L, Barber A, Korona RB, Bakhru RN (2024) Post-ICU clinic. CHEST Crit Care 2:100036

Google Scholar 

Abbood HM, Hijazi K, Gould IM (2023) Chlorhexidine resistance or cross-resistance, that is the question. Antibiotics (Basel) 12:798

CAS  PubMed  Google Scholar 

Zhang M, Jiang Z, Li D, Jiang D, Wu Y, Ren H, Peng H, Lai Y (2015) Oral antibiotic treatment induces skin microbiota dysbiosis and influences wound healing. Microb Ecol 69:415–421

CAS  PubMed  Google Scholar 

Naik S, Bouladoux N, Wilhelm C, Molloy MJ, Salcedo R, Kastenmuller W, Deming C, Quinones M, Koo L, Conlan S, Spencer S, Hall JA, Dzutsev A, Kong H, Campbell DJ, Trinchieri G, Segre JA, Belkaid Y (2012) Compartmentalized control of skin immunity by resident commensals. Science 337:1115–1119

CAS  PubMed  PubMed Central  Google Scholar 

Abeles SR, Jones MB, Santiago-Rodriguez TM, Ly M, Klitgord N, Yooseph S, Nelson KE, Pride DT (2016) Microbial diversity in individuals and their household contacts following typical antibiotic courses. Microbiome 4:39

PubMed  PubMed Central  Google Scholar