Aim: The aim of the study was to assess the influence of non-antibiotic medicationcontributing to MDRO colonisation.Methods: Three hundred twenty-four patients with AD and ACLF admitted to the... Show moreAim: The aim of the study was to assess the influence of non-antibiotic medicationcontributing to MDRO colonisation.Methods: Three hundred twenty-four patients with AD and ACLF admitted to the ICUof Frankfurt University Hospital with MDRO screening were included. Regressionmodels were performed to identify drugs associated with MDRO colonisation.Another cohort (n = 129) from Barcelona was included to validate. A third multi-centre cohort (n = 203) with metagenomic sequencing data of stool was included todetect antibiotic resistance genes.Results: A total of 97 patients (30%) were identified to have MDRO colonisation and35 of them (11%) developed MDRO infection. Patients with MDRO colonisation hadsignificantly higher risk of MDRO infection than those without (p = 0.0098). Apartfrom antibiotic therapy (odds ratio (OR) 2.91, 95%-confidence interval (CI) 1.82–4.93,p < 0.0001), terlipressin therapy in the previous 14 days was the only independentcovariate associated with MDRO colonisation in both cohorts, the overall (OR 9.47,95%-CI 2.96–30.23, p < 0.0001) and after propensity score matching (OR 5.30, 95%-CI 1.22–23.03, p = 0.011). In the second cohort, prior terlipressin therapy was a riskfactor for MDRO colonisation (OR 2.49, 95% CI 0.911–6.823, p = 0.075) and associ-ated with risk of MDRO infection during follow-up (p = 0.017). The validation cohortdemonstrated that antibiotic inactivation genes were significantly associated withterlipressin administration (p = 0.001).Conclusions: Our study reports an increased risk of MDRO colonisation in patientswith AD or ACLF, who recently received terlipressin therapy, while other commonlyprescribed non-antibiotic co-medications had negligible influence. Future prospec-tive trials are needed to confirm these results. Show less
The Programme on Ecosystem Change and Society (PECS) was established in 2011, and is now one of the major international social-ecological systems (SES) research networks. During this time, SES... Show moreThe Programme on Ecosystem Change and Society (PECS) was established in 2011, and is now one of the major international social-ecological systems (SES) research networks. During this time, SES research has undergone a phase of rapid growth and has grown into an influential branch of sustainability science. In this Perspective, we argue that SES research has also deepened over the past decade, and helped to shed light on key dimensions of SES dynamics (e.g. system feedbacks, aspects of system design, goals and paradigms) that can lead to tangible action for solving the major sustainability challenges of our time. We suggest four ways in which the growth of place-based SES research, fostered by networks such as PECS, has contributed to these developments, namely by: 1) shedding light on transformational change, 2) revealing the social dynamics shaping SES, 3) bringing together diverse types of knowledge, and 4) encouraging reflexive researchers. Show less
