Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Lars-Magnus Andersson, Sahlgrenska Universitetssjukhuset, Sweden
- Second opponent: Professor Thea Kølsen Fischer, University of Copenhagen, Denmark
- Third member and chair of the evaluation committee: Professor Anne Margarita Dyrhol Riise, University of Oslo
Chair of the Defence
Associate Professor Harald Hrubos-Strøm, University of Oslo
Principal Supervisor
Professor Magnus Nakrem Lyngbakken, University of Oslo
Summary
Antibiotic overuse is a key driver of antimicrobial resistance, and viral respiratory infections and sepsis are among the most common reasons for antibiotic use in hospitals. Although respiratory viruses are frequently detected in adults with acute respiratory infection, most patients receive antibiotics because of concern about bacterial co-infection, yet evidence of benefit is scarce. In sepsis, the Norwegian first-choice empirical regimen of a narrow-spectrum β-lactam and gentamicin is favorable regarding resistance, but carries a risk of nephrotoxicity.
This thesis aimed to provide evidence to optimize in-hospital antibiotic therapy in these patient groups. It is based on two retrospective cohort studies from Akershus University Hospital and one multicenter randomized controlled trial. The cohort studies examined the association between antibiotic therapy and outcomes in 3979 patients with viral respiratory infection, compared clinical characteristics and outcomes of 2868 patients with respiratory syncytial virus (RSV) and influenza, and compared nephrotoxicity and mortality of narrow-spectrum β-lactam/gentamicin with broad-spectrum β-lactams in 1917 patients with suspected sepsis. The ongoing randomized controlled trial evaluates discontinuing antibiotics after a positive viral PCR with results expected in 2028.
The findings demonstrate that nearly 70% of patients with viral respiratory infection and no evidence of bacterial infection received antibiotics, with no protective association with 30-day mortality. RSV was associated with higher healthcare resource and antibiotic use than influenza, and comparable mortality. Narrow-spectrum β-lactam/gentamicin was not associated with a higher stage of acute kidney injury or death compared with broad-spectrum β-lactams.
These findings indicate that a more restrictive antibiotic strategy may be warranted in viral respiratory infections, and support the current Norwegian guidelines for empirical sepsis therapy.
Additional information
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