{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T07:29:47Z","timestamp":1782890987396,"version":"3.54.5"},"reference-count":18,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,2,27]],"date-time":"2024-02-27T00:00:00Z","timestamp":1708992000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002347","name":"Bundesministerium f\u00fcr Bildung und Forschung","doi-asserted-by":"publisher","award":["DEEP\u2010HCC"],"award-info":[{"award-number":["DEEP\u2010HCC"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["403224013\u2010SFB 1382 (A09)"],"award-info":[{"award-number":["403224013\u2010SFB 1382 (A09)"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Patients with cirrhosis are susceptible to develop bacterial infections that trigger acute decompensation (AD) and acute\u2010on\u2010chronic liver failure (ACLF). Infections with multidrug\u2010resistant organisms (MDRO) are associated with deleterious outcome. MDRO colonisation frequently proceeds MDRO infections and antibiotic therapy has been associated with MDRO colonisation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>The aim of the study was to assess the influence of non\u2010antibiotic medication contributing to MDRO colonisation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Three hundred twenty\u2010four patients with AD and ACLF admitted to the ICU of Frankfurt University Hospital with MDRO screening were included. Regression models were performed to identify drugs associated with MDRO colonisation. Another cohort (<jats:italic>n<\/jats:italic>\u2009=\u2009129) from Barcelona was included to validate. A third multi\u2010centre cohort (<jats:italic>n<\/jats:italic>\u2009=\u2009203) with metagenomic sequencing data of stool was included to detect antibiotic resistance genes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 97 patients (30%) were identified to have MDRO colonisation and 35 of them (11%) developed MDRO infection. Patients with MDRO colonisation had significantly higher risk of MDRO infection than those without (<jats:italic>p<\/jats:italic>\u2009=\u20090.0098). Apart from antibiotic therapy (odds ratio (OR) 2.91, 95%\u2010confidence interval (CI) 1.82\u20134.93, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001), terlipressin therapy in the previous 14\u2009days was the only independent covariate associated with MDRO colonisation in both cohorts, the overall (OR 9.47, 95%\u2010CI 2.96\u201330.23, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) and after propensity score matching (OR 5.30, 95%\u2010CI 1.22\u201323.03, <jats:italic>p<\/jats:italic>\u2009=\u20090.011). In the second cohort, prior terlipressin therapy\u00a0was a risk factor for MDRO colonisation (OR 2.49, 95% CI 0.911\u20136.823, <jats:italic>p<\/jats:italic>\u2009=\u20090.075) and associated with risk of MDRO infection during follow\u2010up (<jats:italic>p<\/jats:italic>\u2009=\u20090.017). The validation cohort demonstrated that antibiotic inactivation genes were significantly associated with terlipressin administration (<jats:italic>p<\/jats:italic>\u2009=\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our study reports an increased risk of MDRO colonisation in patients with AD or ACLF, who recently received terlipressin therapy, while other commonly prescribed non\u2010antibiotic co\u2010medications had negligible influence. Future prospective trials are needed to confirm these results.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.17899","type":"journal-article","created":{"date-parts":[[2024,2,28]],"date-time":"2024-02-28T04:39:49Z","timestamp":1709095189000},"page":"877-888","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Terlipressin therapy is associated with increased risk of colonisation with multidrug\u2010resistant bacteria in patients with decompensated cirrhosis"],"prefix":"10.1111","volume":"59","author":[{"given":"Marcus M.","family":"M\u00fccke","sequence":"first","affiliation":[{"name":"Medical Clinic 1 University Hospital, Goethe\u2010University Frankfurt  Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Hern\u00e1ndez\u2010Tejero","sequence":"additional","affiliation":[{"name":"Liver ICU, Liver Unit, Hospital Clinic University of Barcelona IDIBAPS and CIBERehd  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenyi","family":"Gu","sequence":"additional","affiliation":[{"name":"Medical Clinic 1 University Hospital, Goethe\u2010University Frankfurt  Frankfurt am Main Germany"},{"name":"Department of Internal Medicine B, Muenster University Clinic University of M\u00fcnster  M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Kuhn","sequence":"additional","affiliation":[{"name":"Structural and Computational Biology Unit European Molecular Biology Laboratory  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malte","family":"Janz","sequence":"additional","affiliation":[{"name":"Medical Clinic 1 University Hospital, Goethe\u2010University Frankfurt  Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marisa I.","family":"Keller","sequence":"additional","affiliation":[{"name":"Structural and Computational Biology Unit European Molecular Biology Laboratory  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Fullam","sequence":"additional","affiliation":[{"name":"Structural and Computational Biology Unit European Molecular Biology Laboratory  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Altepeter","sequence":"additional","affiliation":[{"name":"Medical Clinic 1 University Hospital, Goethe\u2010University Frankfurt  Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria T.","family":"M\u00fccke","sequence":"additional","affiliation":[{"name":"Medical Clinic 1 University Hospital, Goethe\u2010University Frankfurt  Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8559-9910","authenticated-orcid":false,"given":"Fabian","family":"Finkelmeier","sequence":"additional","affiliation":[{"name":"Medical Clinic 1 University Hospital, Goethe\u2010University Frankfurt  Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina M.","family":"Schwarzkopf","sequence":"additional","affiliation":[{"name":"Medical Clinic 1 University Hospital, Goethe\u2010University Frankfurt  Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Cremonese","sequence":"additional","affiliation":[{"name":"Medical Clinic 1 University Hospital, Goethe\u2010University Frankfurt  Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter\u2010Merton","family":"Hunyady","sequence":"additional","affiliation":[{"name":"Medical Clinic 1 University Hospital, Goethe\u2010University Frankfurt  Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myriam W.","family":"Heilani","sequence":"additional","affiliation":[{"name":"Medical Clinic 1 University Hospital, Goethe\u2010University Frankfurt  Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank Erhard","family":"Uschner","sequence":"additional","affiliation":[{"name":"Medical Clinic 1 University Hospital, Goethe\u2010University Frankfurt  Frankfurt am Main Germany"},{"name":"Department of Internal Medicine B, Muenster University Clinic University of M\u00fcnster  M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Schierwagen","sequence":"additional","affiliation":[{"name":"Medical Clinic 1 University Hospital, Goethe\u2010University Frankfurt  Frankfurt am Main Germany"},{"name":"Department of Internal Medicine B, Muenster University Clinic University of M\u00fcnster  M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian J.","family":"Brol","sequence":"additional","affiliation":[{"name":"Medical Clinic 1 University Hospital, Goethe\u2010University Frankfurt  Frankfurt am Main Germany"},{"name":"Department of Internal Medicine B, Muenster University Clinic University of M\u00fcnster  M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine B, Muenster University Clinic University of M\u00fcnster  M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Klein","sequence":"additional","affiliation":[{"name":"Medical Clinic 1 University Hospital, Goethe\u2010University Frankfurt  Frankfurt am Main Germany"},{"name":"Department of Internal Medicine B, Muenster University Clinic University of M\u00fcnster  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Institute, King's College London  London UK"},{"name":"Science for Life Laboratory KTH\u2014Royal Institute of Technology  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minneke J.","family":"Coenraad","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Bojunga","sequence":"additional","affiliation":[{"name":"Medical Clinic 1 University Hospital, Goethe\u2010University Frankfurt  Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicente","family":"Arroyo","sequence":"additional","affiliation":[{"name":"European Foundation for the Study of Chronic Liver Failure  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Zeuzem","sequence":"additional","affiliation":[{"name":"Medical Clinic 1 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J.","family":"Kempf","sequence":"additional","affiliation":[{"name":"Institute of Medical Microbiology and Infection Control, Goethe University Frankfurt, Germany University Center for Infectious Diseases University Hospital Frankfurt  Frankfurt Germany"},{"name":"University Center of Competence for Infection Control  State of Hesse Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Welsch","sequence":"additional","affiliation":[{"name":"Medical Clinic 1 University Hospital, Goethe\u2010University Frankfurt  Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wim","family":"Laleman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine B, Muenster University Clinic University of M\u00fcnster  M\u00fcnster Germany"},{"name":"Department of Gastroenterology &amp; Hepatology, Section of Liver and Biliopancreatic Disorders University Hospitals Leuven, KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peer","family":"Bork","sequence":"additional","affiliation":[{"name":"Structural and Computational Biology Unit European Molecular Biology Laboratory  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Liver ICU, Liver Unit, Hospital Clinic University of Barcelona IDIBAPS and CIBERehd  Barcelona Spain"},{"name":"European Foundation for the Study of Chronic Liver Failure  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7028-3881","authenticated-orcid":false,"given":"Jonel","family":"Trebicka","sequence":"additional","affiliation":[{"name":"Medical Clinic 1 University Hospital, Goethe\u2010University Frankfurt  Frankfurt am Main Germany"},{"name":"Department of Internal Medicine B, Muenster University Clinic University of M\u00fcnster  M\u00fcnster Germany"},{"name":"European Foundation for the Study of Chronic Liver Failure  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"MICROB\u2010PREDICT and PREDICT Study Group of the EASL\u2010CLIF Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.02.042"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13568"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.06.013"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-314240"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.10.027"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.07.046"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.12.005"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.11.019"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.03.024"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa010307"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix112"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz540"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2014-309104"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0618-8278(19)31288-5"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature25979"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.12.042"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.14309\/ctg.0000000000000223"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-019-14177-z"}],"container-title":["Alimentary Pharmacology &amp; 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