Magrit Jarlsdatter Hovind

• Hovind, Magrit Jarlsdatter; Berdal, Jan-Erik; Benth, Jurate Saltyte; Dalgard, Olav & Lyngbakken, Magnus Nakrem (2026). Antibiotic therapy in viral airway infections (ATHENIAN): study protocol for an open labeled randomized controlled pragmatic trial to evaluate the efficacy and safety of discontinuing antibiotic therapy in adult patients infected with respiratory viruses. Trials. 27(1). doi: 10.1186/s13063-026-09730-3. Full text in Research Archive Show summary

  Background Reducing inappropriate use of antibiotics is essential to combat antimicrobial resistance. Antibiotics are widely prescribed upon hospital admission for acute respiratory infections, but it remains unknown whether it is safe to discontinue antibiotics when a respiratory virus is detected in these patients. With this randomized trial, we aim to assess the efficacy and safety of discontinuing antibiotic therapy in patients admitted to the hospital with a polymerase chain reaction test positive for respiratory virus and no clear evidence of bacterial infection. Methods ATHENIAN is an ongoing multicenter, open-label, pragmatic, randomized non-inferiority trial. We aim to recruit 400 adult patients initiated on antibiotic therapy at admittance to one of the 10 study sites in Norway and with a positive polymerase chain reaction test for influenza virus, human metapneumovirus, respiratory syncytial virus, or parainfluenza virus. The participants are randomized to intervention, discontinuation of antibiotic therapy, or control, continuation of antibiotic therapy at the discretion of the treating physician. We hypothesize that discontinuation of antibiotic therapy is safe and non-inferior to continuation of antibiotic therapy. The primary outcome, assessed at 120 h after randomization, is early clinical response, defined as survival with symptom improvement without receipt of rescue antibacterial therapy. Secondary outcomes include all-cause in-hospital and 30-day mortality, duration of hospital admission, days of therapy with antibiotics, rescue antibiotic therapy during hospital admission, new antibiotic therapy for presumed airway infection up to 30 days after hospital discharge, and hospital readmissions within 30 days after hospital discharge. Discussion To our knowledge, ATHENIAN is the first randomized controlled trial assessing the safety and efficacy of antimicrobial de-escalation based on multiplex nucleic acid amplification test results. Addressing this knowledge gap using a pragmatic study design will provide valuable insights that may influence treatment algorithms and antibiotic prescription practices. The study has the potential to contribute to a reduction in the inappropriate use of antibiotics and the emergence of antimicrobial resistance. Trial registration ClinicalTrials.gov NCT05045612. Registered on September 7, 2021.

• Neumann, Kirill; Hovind, Magrit Jarlsdatter; Berdal, Jan-Erik; Dalgard, Olav; Leegaard, Truls Michael & Siljan, William Ward [Show all 8 contributors for this article] (2026). Acute Respiratory Failure and Ventilatory Support in Hospitalized Adults With Viral Respiratory Infection: A Retrospective Cohort Study. Open Forum Infectious Diseases. 13(4). doi: 10.1093/ofid/ofag189. Full text in Research Archive
• Hovind, Magrit Jarlsdatter; Berdal, Jan-Erik; Dalgard, Olav & Lyngbakken, Magnus Nakrem (2026). A comparison of clinical characteristics and mortality in hospitalised patients with respiratory syncytial virus and influenza virus infections: a cohort study. Infectious Diseases. ISSN 2374-4235. doi: 10.1080/23744235.2026.2621994. Full text in Research Archive
• Hovind, Magrit Jarlsdatter; Berdal, Jan-Erik; Dalgard, Olav & Lyngbakken, Magnus Nakrem (2025). Empiric Antibiotic Therapy in Suspected Sepsis: Impact of Gentamicin-Based Regimens on Incident Renal Failure and Mortality. Open Forum Infectious Diseases. 12(6). doi: 10.1093/ofid/ofaf319. Full text in Research Archive Show summary

  Background The efficacy and safety of administering a narrow-spectrum β-lactam and gentamicin as empirical therapy for community-acquired sepsis has been questioned. We compared the efficacy and safety of this combination with that of broad-spectrum β-lactams (cefotaxime, piperacillin-tazobactam, or meropenem) in patients with suspected sepsis. Methods In this retrospective study, we included patients initiated on narrow-spectrum β-lactam/gentamicin or broad-spectrum β-lactams for suspected sepsis between January 2017 and December 2022. Patients without baseline creatinine and at least 1 subsequent creatinine measurement were excluded. We compared the impact of antibiotic regimens using a 5-level ordinal outcome scale ranging from no acute kidney injury (AKI) to all-cause death during 30-day follow-up. Results Among 1917 patients, 33.1% received narrow-spectrum β-lactam/gentamicin, and 66.9% received broad-spectrum β-lactams. Patients initiated on broad-spectrum β-lactams had more comorbidities, had lower estimated glomerular filtration rate on admission, and more frequently required treatment with noradrenaline, respiratory support, and admission to the intensive care and medical intermediate care units. Therapy with broad-spectrum β-lactams was associated with a higher posttreatment stage of AKI or death (adjusted odds ratio, 1.61 [95% confidence interval, 1.27–2.04]). We found no significant association between cumulative dose of gentamicin and peak creatinine value. For patients treated with gentamicin experiencing AKI, creatinine normalized during 30-day follow-up. Conclusions In patients with suspected sepsis, empirical treatment with narrow-spectrum β-lactam/gentamicin was not associated with an increased risk of AKI or death. If local antimicrobial resistance patterns permit, narrow-spectrum β-lactam/gentamicin may reduce broad-spectrum β-lactam usage, addressing a key element of antibiotic stewardship.

• Hovind, Magrit Jarlsdatter; Berdal, Jan-Erik; Dalgard, Olav & Lyngbakken, Magnus Nakrem (2024). Impact of antibiotic therapy in patients with respiratory viral infections: a retrospective cohort study. Infectious Diseases. ISSN 2374-4235. 56(12), p. 1031–1039. doi: 10.1080/23744235.2024.2375592. Full text in Research Archive Show summary

  Objectives The impact of antibiotics in patients with positive polymerase chain reaction (PCR) for respiratory viruses without evidence of a respiratory bacterial co-infection is largely unknown. The aim of this study was to assess the association of antibiotics on 30-day mortality and length of hospital stay in patients with an acute respiratory infection and PCR documented presence of respiratory viruses. Methods We conducted a retrospective cohort study of adult patients admitted to hospital between 2012 and 2021 with positive PCR for influenza virus (H3N2, H1N1, influenza B), respiratory syncytial virus, human metapneumovirus or severe acute respiratory syndrome coronavirus 2. We used logistic regression, the Kaplan–Meier estimator and Poisson’s regression to assess the impact of antibiotic therapy on outcomes. Results Among 3979 patients, 67.7% received antibiotics. In adjusted analyses, antibiotics initiated in the emergency department (adjusted OR 1.23, 95% CI 0.77–1.96) and days of antibiotic therapy (adjusted OR per day of therapy 0.98, 95% CI 0.95–1.00) had no significant impact on mortality, whereas antibiotics initiated later during admission (adjusted OR 2.25, 95% CI 1.26–4.02) was associated with increased mortality. Patients prescribed antibiotics had longer duration of hospital admission. Conclusions We observed no protective association between in-hospital antibiotic therapy and outcomes, suggesting overuse of antibiotics in respiratory infections with proven respiratory viruses. A restrictive antibiotic strategy may be warranted.

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