[Comment] Repopulate, not just decolonise—a microbial ecological strategy against multidrug resistance in intensive care units

The fight against multidrug-resistant organisms (MDROs) in hospitals, especially in critical care settings, has led to the widespread use of universal decolonisation with chlorhexidine and mupirocin. However, growing evidence raises concerns regarding unintended consequences, notably the selective pressure that biocides exert, promoting microbial communities dominated by resistant strains. In their recent Article published in The Lancet Microbe, Sara Sharaf and colleagues1 highlight the risk of unintended consequences of biocides, showing that shifting from universal to targeted decolonisation in intensive care units (ICUs) considerably reduced meticillin-resistant Staphylococcus epidermidis bloodstream infections, without increasing overall infection rates.