In this cluster randomized multicenter study in 13 European ICUs, decontamination strategies with either antibiotics (SDD or SOD) or CHX mouthwash were not associated with reductions in ICU-acquired BSI with MDRGNB, nor mortality, in ventilated ICU patients when compared with standard care, which included universal daily BWs with CHX during ICU stay and a hand hygiene program. Furthermore, the unitwide prevalence of carriage with antibiotic-resistant bacteria did not change during the interventions, which is consistent with results obtained in all large SDD trials of the last 20 years. The strengths of this study include participation of ICUs in 6 European countries, with resistance rates that better reflect the average European or American setting than Dutch ICUs, thereby improving external validity and generalizability of findings, as well as the detailed unitwide resistance monitoring with monthly point prevalence studies.

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