Jan-Erik Berdal

• 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. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 8 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Juul, Frederik Emil; Bretthauer, Michael; Johnsen, Peter Holger; Samy, Faye; Tonby, Kristian & Berdal, Jan-Erik [Vis alle 29 forfattere av denne artikkelen] (2025). Fecal Microbiota Transplantation Versus Vancomycin for Primary Clostridioides difficile Infection : A Randomized Controlled Trial. Annals of Internal Medicine. ISSN 0003-4819. 178(7), s. 940–947. doi: 10.7326/ANNALS-24-03285. Fulltekst i vitenarkiv
• 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), s. 1031–1039. doi: 10.1080/23744235.2024.2375592. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Mesinovic, Munib; Wong, Xin Ci; Rajahram, Giri Shan; Citarella, Barbara Wanjiru; Peariasamy, Kalaiarasu M. & Greve, Frank van Someren [Vis alle 1 671 forfattere av denne artikkelen] (2024). At-admission prediction of mortality and pulmonary embolism in an international cohort of hospitalised patients with COVID-19 using statistical and machine learning methods. Scientific Reports. 14(1). doi: 10.1038/s41598-024-63212-7. Fulltekst i vitenarkiv
• Prebensen, Christian Haugland; Lefol, Yohan Pierre; Myhre, Peder Langeland; Lüders, Torben; Jonassen, Christine M & Blomfeldt, Anita [Vis alle 9 forfattere av denne artikkelen] (2023). Longitudinal whole blood transcriptomic analysis characterizes neutrophil activation and interferon signaling in moderate and severe COVID-19. Scientific Reports. 13(1). doi: 10.1038/s41598-023-37606-y. Fulltekst i vitenarkiv Vis sammendrag

  Abstract A maladaptive inflammatory response has been implicated in the pathogenesis of severe COVID-19. This study aimed to characterize the temporal dynamics of this response and investigate whether severe disease is associated with distinct gene expression patterns. We performed microarray analysis of serial whole blood RNA samples from 17 patients with severe COVID-19, 15 patients with moderate disease and 11 healthy controls. All study subjects were unvaccinated. We assessed whole blood gene expression patterns by differential gene expression analysis, gene set enrichment, two clustering methods and estimated relative leukocyte abundance using CIBERSORT. Neutrophils, platelets, cytokine signaling, and the coagulation system were activated in COVID-19, and this broad immune activation was more pronounced in severe vs. moderate disease. We observed two different trajectories of neutrophil-associated genes, indicating the emergence of a more immature neutrophil phenotype over time. Interferon-associated genes were strongly enriched in early COVID-19 before falling markedly, with modest severity-associated differences in trajectory. In conclusion, COVID-19 necessitating hospitalization is associated with a broad inflammatory response, which is more pronounced in severe disease. Our data suggest a progressively more immature circulating neutrophil phenotype over time. Interferon signaling is enriched in COVID-19 but does not seem to drive severe disease.

• Handal, Nina; Whitworth, Jimmy; Lyngbakken, Magnus Nakrem; Berdal, Jan-Erik; Dalgard, Olav & Jørgensen, Silje Bakken (2023). Mortality and length of hospital stay after bloodstream infections caused by ESBL-producing compared to non-ESBL-producing E. coli. Infectious Diseases. ISSN 2374-4235. 56(1), s. 19–31. doi: 10.1080/23744235.2023.2261538. Fulltekst i vitenarkiv Vis sammendrag

  Objective To compare mortality and length of hospital stay between patients with ESBL-producing E. coli bloodstream infections (BSIs) and patients with non-ESBL E. coli BSIs. We also aimed at describing risk factors for ESBL-producing E. coli BSIs and time to effective antibiotic treatment for the two groups. Methods A retrospective case-control study among adults admitted between 2014 and 2021 to a Norwegian University Hospital. Results A total of 468 E. coli BSI episodes from 441 patients were included (234 BSIs each in the ESBL- and non-ESBL group). Among the ESBL-producing E. coli BSIs, 10.9% (25/230) deaths occurred within 30 days compared to 9.0% (21/234) in the non-ESBL group. The adjusted 30-day mortality OR was 1.6 (95% CI 0.7–3.7, p = 0.248). Effective antibiotic treatment was administered within 24 hours to 55.2% (129/234) in the ESBL-group compared to 86.8% (203/234) in the non-ESBL group. Among BSIs of urinary tract origin (n = 317), the median length of hospital stay increased by two days in the ESBL group (six versus four days, p < 0.001). No significant difference in the length of hospital stay was found for other sources of infection (n = 151), with a median of seven versus six days (p = 0.550) in the ESBL- and non-ESBL groups, respectively. Conclusion There was no statistically significant difference in 30-day mortality in ESBL-producing E. coli compared to non-ESBL E. coli BSI, despite a delay in the administration of an effective antibiotic in the former group. ESBL-production was associated with an increased length of stay in BSIs of urinary tract origin.

• Lefol, Yohan Pierre; Korfage, Tom; Mjelle, Robin; Prebensen, Christian Haugland; Lüders, Torben & Müller, Bruno [Vis alle 13 forfattere av denne artikkelen] (2023). TiSA: TimeSeriesAnalysis - A pipeline for the analysis of longitudinal transcriptomics data. NAR Genomics and Bioinformatics. 5(1). doi: 10.1093/nargab/lqad020. Fulltekst i vitenarkiv Vis sammendrag

  Improved transcriptomic sequencing technologies now make it possible to perform longitudinal experiments, thus generating a large amount of data. Currently, there are no dedicated or comprehensive methods for the analysis of these experiments. In this article, we describe our TimeSeries Analysis pipeline (TiSA) which combines differential gene expression, clustering based on recursive thresholding, and a functional enrichment analysis. Differential gene expression is performed for both the temporal and conditional axes. Clustering is performed on the identified differentially expressed genes, with each cluster being evaluated using a functional enrichment analysis. We show that TiSA can be used to analyse longitudinal transcriptomic data from both microarrays and RNA-seq, as well as small, large, and/or datasets with missing data points. The tested datasets ranged in complexity, some originating from cell lines while another was from a longitudinal experiment of severity in COVID-19 patients. We have also included custom figures to aid with the biological interpretation of the data, these plots include Principal Component Analyses, Multi Dimensional Scaling plots, functional enrichment dotplots, trajectory plots, and complex heatmaps showing the broad overview of results. To date, TiSA is the first pipeline to provide an easy solution to the analysis of longitudinal transcriptomics experiments.

• Søvik, Signe; Barratt-Due, Andreas; Kåsine, Trine; Olasveengen, Theresa M.; Strand, Marianne Wigernes & Tveita, Anders Aune [Vis alle 16 forfattere av denne artikkelen] (2022). Corticosteroids and superinfections in COVID-19 patients on invasive mechanical ventilation. Journal of Infection. ISSN 0163-4453. 85(1), s. 57–63. doi: 10.1016/j.jinf.2022.05.015. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To determine the incidence and characteristics of superinfections in mechanically ventilated COVID-19 patients, and the impact of dexamethasone as standard therapy. Methods This multicentre, observational, retrospective study included patients ≥ 18 years admitted from March 1st 2020 to January 31st 2021 with COVID-19 infection who received mechanical ventilation. Patient characteristics, clinical characteristics, therapy and survival were examined. Results 155/156 patients (115 men, mean age 62 years, range 26-84 years) were included. 67 patients (43%) had 90 superinfections, pneumonia dominated (78%). Superinfections were associated with receiving dexamethasone (66% vs 32%, p<0.0001), autoimmune disease (18% vs 5.7%, p<0.016) and with longer ICU stays (26 vs 17 days, p<0,001). Invasive fungal infections were reported exclusively in dexamethasone-treated patients [8/67 (12%) vs 0/88 (0%), p<0.0001]. Unadjusted 90-day survival did not differ between patients with or without superinfections (64% vs 73%, p=0.25), but was lower in patients receiving dexamethasone versus not (58% vs 78%, p=0.007). In multiple regression analysis, superinfection was associated with dexamethasone use [OR 3.7 (1.80–7.61), p<0.001], pre-existing autoimmune disease [OR 3.82 (1.13–12.9), p=0.031] and length of ICU stay [OR 1.05 p<0.001]. Conclusions In critically ill COVID-19 patients, dexamethasone as standard of care was strongly and independently associated with superinfections.

• Garcia-Gallo, Esteban; Merson, Laura; Kennon, Kalynn; Kelly, Sadie; Citarella, Barbara Wanjiru & Fryer, Daniel Vidali [Vis alle 1 775 forfattere av denne artikkelen] (2022). ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19. Scientific Data. 9(1). doi: 10.1038/s41597-022-01534-9. Fulltekst i vitenarkiv Vis sammendrag

  The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use.

• Bouziotis, Jason; Arvanitakis, Marianna; Preiser, Jean-Charles; Abbas, Ali; Abdukahil, Sheryl Ann & Abdulkadir, Nurul Najmee [Vis alle 50 forfattere av denne artikkelen] (2022). Association of body mass index with COVID-19 related in-hospital death. Clinical Nutrition. ISSN 0261-5614. 41(12), s. 2924–2926. doi: 10.1016/j.clnu.2022.01.017. Fulltekst i vitenarkiv Vis sammendrag

  Background: Patients with extreme body mass indices (BMI) could have an increased risk of death while hospitalized for COVID-19.<p> <p>Methods: The database of the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) was used to assess the time to in-hospital death with competing-risks regression by sex and between the categories of BMI. <p>Results: Data from 12,137 patients (age 60.0 ± 16.2 years, 59% males, BMI 29.4 ± 6.9 kg/m² ) of 48 countries were available. By univariate analysis, underweight patients had a higher risk of mortality than the other patients (sub-hazard ratio (SHR) 1.75 [1.44e2.14]). Mortality was lower in normal (SHR 0.69 [0.58e0.85]), overweight (SHR 0.53 [0.43e0.65]) and obese (SHR 0.55 [0.44e0.67]) than in underweight patients. Multivariable analysis (adjusted for age, chronic pulmonary disease, malignant neoplasia, type 2 diabetes) confirmed that in-hospital mortality of underweight patients was higher than overweight patients (females: SHR 0.63 [0.45e0.88] and males: 0.69 [0.51e0.94]). <p>Conclusion: Even though these findings do not imply changes in the medical care of hospitalized patients, they support the use of BMI category for the stratification of patients enrolled in interventional studies where mortality is recorded as an outcome.

• Cho, Sung-Min; White, Nicole; Premraj, Lavienraj; Battaglini, Denise; Fanning, Jonathon & Suen, Jacky [Vis alle 50 forfattere av denne artikkelen] (2022). Neurological manifestations of COVID-19 in adults and children. Brain. ISSN 0006-8950. doi: 10.1093/brain/awac332. Fulltekst i vitenarkiv
• Reyes, Luis Felipe; Murthy, Srinivas; Garcia-Gallo, Esteban; Merson, Laura; Ibáñez-Prada, Elsa D. & Rello, Jordi [Vis alle 51 forfattere av denne artikkelen] (2022). Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study. Critical Care. ISSN 1364-8535. 26(1). doi: 10.1186/s13054-022-04155-1. Fulltekst i vitenarkiv
• Wainstein, Marina; MacDonald, Samual; Fryer, Daniel; Young, Kyle; Balan, Valeria & Begum, Husna [Vis alle 50 forfattere av denne artikkelen] (2022). Use of an extended KDIGO definition to diagnose acute kidney injury in patients with COVID-19: A multinational study using the ISARIC–WHO clinical characterisation protocol. PLoS Medicine. ISSN 1549-1277. 19(4). doi: 10.1371/journal.pmed.1003969. Fulltekst i vitenarkiv
• Myhre, Peder Langeland; Heck, Siri Lagethon; Skranes, Julia Brox; Prebensen, Christian Haugland; Jonassen, Christine M & Berge, Trygve [Vis alle 15 forfattere av denne artikkelen] (2021). Cardiac pathology 6 months after hospitalization for COVID-19 and association with the acute disease severity. American Heart Journal. ISSN 0002-8703. 242, s. 61–70. doi: 10.1016/j.ahj.2021.08.001. Fulltekst i vitenarkiv Vis sammendrag

  Background Coronavirus disease 2019 (COVID-19) may cause myocardial injury and myocarditis, and reports of persistent cardiac pathology after COVID-19 have raised concerns of long-term cardiac consequences. We aimed to assess the presence of abnormal cardiovascular resonance imaging (CMR) findings in patients recovered from moderate-to-severe COVID-19, and its association with markers of disease severity in the acute phase. Methods Fifty-eight (49%) survivors from the prospective COVID MECH study, underwent CMR median 175 [IQR 105-217] days after COVID-19 hospitalization. Abnormal CMR was defined as left ventricular ejection fraction (LVEF) <50% or myocardial scar by late gadolinium enhancement. CMR indices were compared to healthy controls (n = 32), and to circulating biomarkers measured during the index hospitalization. Results Abnormal CMR was present in 12 (21%) patients, of whom 3 were classified with major pathology (scar and LVEF <50% or LVEF <40%). There was no difference in the need of mechanical ventilation, length of hospital stay, and vital signs between patients with vs without abnormal CMR after 6 months. Severe acute respiratory syndrome coronavirus 2 viremia and concentrations of inflammatory biomarkers during the index hospitalization were not associated with persistent CMR pathology. Cardiac troponin T and N-terminal pro-B-type natriuretic peptide concentrations on admission, were higher in patients with CMR pathology, but these associations were not significant after adjusting for demographics and established cardiovascular disease. Conclusions CMR pathology 6 months after moderate-to-severe COVID-19 was present in 21% of patients and did not correlate with severity of the disease. Cardiovascular biomarkers during COVID-19 were higher in patients with CMR pathology, but with no significant association after adjusting for confounders. Trial Registration COVID MECH Study ClinicalTrials.gov Identifier: NCT04314232

• Myhre, Peder L.; Prebensen, Christian; Jonassen, Christine Monceyron; Berdal, Jan Erik & Omland, Torbjørn (2021). Sars-cov-2 viremia is associated with inflammatory, but not cardiovascular biomarkers, in patients hospitalized for covid-19. Journal of the American Heart Association (JAHA). 10(9), s. 1–5. doi: 10.1161/JAHA.120.019756. Fulltekst i vitenarkiv Vis sammendrag

  Background COVID‐19 may present with a variety of cardiovascular manifestations, and elevations of biomarkers reflecting myocardial injury and stress are prevalent. SARS‐CoV‐2 has been found in cardiac tissue, and myocardial dysfunction post‐COVID‐19 may occur. However, the association between SARS‐CoV‐2 RNA in plasma and cardiovascular biomarkers remains unknown. Methods and Results COVID MECH (COVID‐19 Mechanisms) was a prospective, observational study enrolling consecutive, hospitalized patients with laboratory‐confirmed infection with SARS‐CoV‐2 and symptoms of COVID‐19. Biobank plasma samples used to measure SARS‐CoV‐2 RNA and cardiovascular and inflammatory biomarkers were collected in 123 patients at baseline, and in 96 patients (78%) at day 3. Patients were aged 60±15 (mean ± SD) years, 71 (58%) were men, 68 (55%) were White, and 31 (25%) received mechanical ventilation during hospitalization. SARS‐CoV‐2 RNA was detected in plasma from 48 (39%) patients at baseline. Patients with viremia were more frequently men, had more diabetes mellitus, and lower oxygen saturation. Patients with viremia had higher concentrations of interleukin‐6, C‐reactive protein, procalcitonin, and ferritin (all <0.001), but comparable levels of cTnT (cardiac troponin T; P=0.09), NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide; P=0.27) and D‐dimer (P=0.67) to patients without viremia. SARS‐CoV‐2 RNA was present in plasma at either baseline or day 3 in 50 (52%) patients, and these patients experienced increase from baseline to day 3 in NT‐proBNP and D‐dimer concentrations, while there was no change in cTnT. Conclusions SARS‐CoV‐2 viremia was associated with increased concentrations of inflammatory, but not cardiovascular biomarkers. NT‐proBNP and D‐dimer, but not cTnT, increased from baseline to day 3 in patients with viremia. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04314232.

• Morland, Mona; Haagensen, Rolf E; Dahl, Fredrik A.; Husby, Haldor & Berdal, Jan-Erik (2021). Langtidsprognose for pasienter innlagt i en medisinsk overvåkningsavdeling. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(9), s. 1–9. doi: 10.4045/tidsskr.20.0961. Fulltekst i vitenarkiv Vis sammendrag

  BAKGRUNN Medisinsk overvåkning på Akershus universitetssykehus behandler pasienter med truende eller manifest organsvikt. Å velge ut pasienter som vil ha nytte av behandling i en overvåkningsavdeling, er krevende. Det finnes lite data på langtidsoverlevelse for pasienter behandlet i medisinske overvåkningsavdelinger og på hvordan antatte gunstige og ugunstige prognostiske faktorer predikerer langtidsoverlevelse i denne populasjonen. MATERIALE OG METODE Prospektiv registrering av komorbiditet, innleggelsesårsak og om infeksjon var direkte eller medvirkende årsak til innleggelsen, ble utført for pasienter ved avdelingen i 2014 og 2016. Vi registrerte mortalitet inntil seks år etter innleggelsen og utførte logistisk regresjonsanalyse med tre års overlevelse som utfallsvariabel. RESULTATER Av 2 170 pasienter som ble inkludert, døde 153 pasienter (7 %) på overvåkningsavdelingen. Av de 2 017 pasientene som ble utskrevet fra overvåkningsavdelingen i live, var 55 % fortsatt i live tre år senere, inkludert 28 % av eldre over 80 år og 23 % av pasienter med kreftsykdom. Alder, malignitet, annen komorbiditet og infeksjon var prediktorer for død. FORTOLKNING Mange pasientgrupper i en overvåkningsavdeling har en dårlig langtidsprognose. Eldre over 80 år, kreftsyke eller pasienter med annen alvorlig komorbiditet kan imidlertid leve lenge etter opphold på en overvåkningsavdeling, og tilhørighet til disse gruppene bør ikke være selvstendig årsak til å unnlate å gi et behandlingstilbud. Hovedfunn Pasienter på medisinsk overvåkning er en svært heterogen gruppe hva gjelder alder, komorbiditet og langtidsprognose. Pasienter over 80 år og kreftpasienter kan overleve lenge etter behandling i en overvåkningsavdeling og beslaglegger ikke vesentlig mer ressurser målt i liggetid enn øvrige pasienter. Alvorlig infeksjon ved innleggelsen er assosiert med økt risiko for død også flere år senere.

• Handal, Nina; Whitworth, Jimmy; Blomfeldt, Anita; Espvik, Heidi Johanne; Lysaker, Elisabeth & Berdal, Jan Erik [Vis alle 7 forfattere av denne artikkelen] (2021). Comparison of SARS-CoV-2 infections in healthcare workers with high and low exposures to Covid-19 patients in a Norwegian University Hospital. Infectious Diseases. ISSN 2374-4235. 53(6), s. 420–429. doi: 10.1080/23744235.2021.1885734. Fulltekst i vitenarkiv
• Omland, Torbjørn; Prebensen, Christian Haugland; Jonassen, Christine M; Svensson, My Hanna Sofia; Berdal, Jan-Erik & Seljeflot, Ingebjørg [Vis alle 7 forfattere av denne artikkelen] (2021). Soluble ST2 concentrations associate with in-hospital mortality and need for mechanical ventilation in unselected patients with COVID-19. Open heart. 8(2), s. 1–7. doi: 10.1136/openhrt-2021-001884. Fulltekst i vitenarkiv Vis sammendrag

  Objective Soluble ST2 (sST2) reflects inflammation, endothelial dysfunction and myocardial fibrosis, is produced in the lungs and is an established biomarker in heart failure. We sought to determine the role of sST2 in COVID-19 by assessing pathophysiological correlates and its association to in-hospital outcomes. Methods We enrolled 123 consecutive, hospitalised patients with COVID-19 in the prospective, observational COVID-19 MECH study. Biobank samples were collected at baseline, day 3 and day 9. The key exposure variable was sST2, and the outcome was ICU treatment with mechanical ventilation or in-hospital death. Results Concentrations of sST2 at baseline was median 48 (IQR 37–67) ng/mL, and 74% had elevated concentrations (>37.9 ng/mL). Higher baseline sST2 concentrations were associated with older age, male sex, white race, smoking, diabetes, hypertension and chronic kidney disease. Baseline sST2 also associated with the presence of SARS-CoV-2 viraemia, lower oxygen saturation, higher respiratory rate and increasing concentrations of biomarkers reflecting inflammation, thrombosis and cardiovascular disease. During the hospitalisation, 8 (7%) patients died and 27 (22%) survivors received intensive care unit (ICU) treatment. Baseline sST2 concentrations demonstrated a graded association with disease severity (median, IQR): medical ward 43 (36–59) ng/mL; ICU 67 (39–104) ng/mL and non-survivors 107 (72–116) ng/mL (p<0.001 for all comparisons). These associations persisted at day 3 and day 9 . Conclusions sST2 concentrations associate with SARS-CoV-2 viraemia, hypoxaemia and concentrations of inflammatory and cardiovascular biomarkers. There was a robust association between baseline sST2 and disease severity that was independent of, and superior to, established risk factors. sST2 reflects key pathophysiology and may be a promising biomarker in COVID-19.

• Prebensen, Christian; Myhre, Peder Langeland; Jonassen, Christine M; Rangberg, Anbjørg; Blomfeldt, Anita & Svensson, My Hanna Sofia [Vis alle 8 forfattere av denne artikkelen] (2020). Severe Acute Respiratory Syndrome Coronavirus 2 RNA in Plasma Is Associated with Intensive Care Unit Admission and Mortality in Patients Hospitalized with Coronavirus Disease 2019. Clinical Infectious Diseases. ISSN 1058-4838. 73(3). doi: 10.1093/cid/ciaa1338. Fulltekst i vitenarkiv
• Lyngbakken, Magnus; Berdal, Jan Erik; Eskesen, Arne N; Kvale, Dag; Olsen, Inge Christoffer & Rueegg, Corina Silvia [Vis alle 11 forfattere av denne artikkelen] (2020). A pragmatic randomized controlled trial reports lack of efficacy of hydroxychloroquine on coronavirus disease 2019 viral kinetics. Nature Communications. 11:5284, s. 1–6. doi: 10.1038/s41467-020-19056-6. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Here, we randomized 53 patients hospitalized with coronavirus disease 2019 (COVID-19) to hydroxychloroquine therapy (at a dose of 400 mg twice daily for seven days) in addition to standard care or standard care alone (ClinicalTrials.gov Identifier, NCT04316377). All severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive patients 18 years of age or older were eligible for study inclusion if they had moderately severe COVID-19 at admission. Treatment with hydroxychloroquine did not result in a significantly greater rate of decline in SARS-CoV-2 oropharyngeal viral load compared to standard care alone during the first five days. Our results suggest no important antiviral effect of hydroxychloroquine in humans infected with SARS-CoV-2.

• Omland, Torbjørn; Prebensen, Christian; Røysland, Ragnhild; Søvik, Signe; Sørensen, Vibecke & Røsjø, Helge [Vis alle 9 forfattere av denne artikkelen] (2020). Established Cardiovascular Biomarkers Provide Limited Prognostic Information in Unselected Patients Hospitalized with COVID-19. Circulation. ISSN 0009-7322. 19, s. 1878–1880. doi: 10.1161/CIRCULATIONAHA.120.050089. Fulltekst i vitenarkiv
• Myhre, Peder Langeland; Prebensen, Christian; Strand, Heidi; Røysland, Ragnhild; Jonassen, Christine M. & Rangberg, Anbjørg [Vis alle 12 forfattere av denne artikkelen] (2020). Growth Differentiation Factor-15 Provides Prognostic Information Superior to Established Cardiovascular and Inflammatory Biomarkers in Unselected Patients Hospitalized with COVID-19. Circulation. ISSN 0009-7322. doi: 10.1161/CIRCULATIONAHA.120.050360. Fulltekst i vitenarkiv
• Søvik, Signe; Bådstøløkken, Per Martin; Sørensen, Vibecke; Myhre, Peder Langeland; Prebensen, Christian & Omland, Torbjørn [Vis alle 7 forfattere av denne artikkelen] (2020). A single‐centre, prospective cohort study of COVID‐19 patients admitted to ICU for mechanical ventilatory support. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. doi: 10.1111/aas.13726. Fulltekst i vitenarkiv Vis sammendrag

  Background Mortality rates in COVID‐19 patients in need of mechanical ventilation are high, with wide variations between countries. Most studies were retrospective, and results may not be generalizable due to differences in demographics, healthcare organization and surge capacity. We present a cohort of mechanically ventilated COVID‐19 patients from a resource‐rich, publicly financed healthcare system. Methods Prospective study from a tertiary hospital. Consecutive SARS‐CoV‐2 positive adult patients admitted to the ICU for mechanical ventilation from 10 March 2020 to 04 May 2020 were included. Triage and treatment were protocolized. High‐dose dalteparin was adjusted by D‐dimer. Demographics, treatments and high‐resolution physiological variables were collected. Outcomes were 30‐day and hospital mortality. Data are medians (quartiles). Results Of the 1484 persons in the hospital catchment area testing positive for SARS‐CoV‐2, 201 (13.5%) were hospitalized. Thirty‐eight (19%) patients were mechanically ventilated, of whom five (13%) died. Of the 163 patients treated with supplemental oxygen, eight (5%) died. In ventilated patients (75% males, age 61 (53‐70) years), severe, moderate and mild ARDS was present in 25%, 70% and 5%. Tidal volume ≤8 mL/kg ideal bodyweight was achieved in 34 (94%) patients. Proning and neuromuscular blockers were used in 19 (54%) and 20 (61%) patients. Duration of ventilation was 12 days (8‐23). D‐dimer peaked at 3.8 mg/L (2.1‐5.3), and maximum dalteparin dose was 15 000 IU/24 h (10 000‐15 000). Despite organizational changes, a high degree of adherence to treatment protocols was achieved. Conclusion In a prospective cohort study of mechanically ventilated COVID‐19 patients treated in a resource‐rich, publicly financed healthcare system, mortality was considerably lower than previously reported in retrospective studies.

• Hesstvedt, Liv; Gaustad, Peter; Müller, Fredrik; Andersen, Cecilie Torp; Brunborg, Cathrine & Mylvaganam, Haima [Vis alle 19 forfattere av denne artikkelen] (2019). The impact of age on risk assessment, therapeutic practice and outcome in candidemia. Infectious Diseases. ISSN 2374-4235. 51(6), s. 425–434. doi: 10.1080/23744235.2019.1595709. Fulltekst i vitenarkiv
• Berdal, Jan Erik; Follin-Arbelet, Benoit & Bjørnholt, Jørgen Vildershøj (2019). Experiences from multiplex PCR diagnostics of faeces in hospitalised patients: Clinical significance of Enteropathogenic Escherichia coli (EPEC) and culture negative campylobacter. BMC Infectious Diseases. 19(1). doi: 10.1186/s12879-019-4271-1. Fulltekst i vitenarkiv Vis sammendrag

  Background In hospitalised patients with diarrhoea a positive campylobacter stool Polymerase Chain Reaction (PCR) test with negative culture results as well as Enteropathogenic Escherichia coli (EPEC) positive stool PCRs, challenges the clinician and may lead the unexperienced clinician astray. The aim of the study was to elucidate the clinical significance of positive Campylobacter and/or EPEC test results in hospitalised patients with diarrhoea. Methods We conducted a retrospective case-case study. Case groups with 1) EPEC only and 2) EPEC in combination with any other pathogen in the PCR multiplex array, 3) PCR positive/culture negative Campylobacter, and 4) PCR positive/culture positive Campylobacter were compared. Medical records were reviewed and cases classified according to pre-specified clinical criteria as infectious gastroenteritis or non-infectious causes for diarrhoea. We analyzed the association between laboratory findings (the 4 subgroups) and the pre-specified clinical classification. We further sequenced culture negative campylobacter samples and tested EPEC for bundle forming pilus A (bfpA) gene, distinguishing typical from atypical EPEC. Results A total of 291 patients were included, 169 were PCR positive for Campylobacter and 122 for EPEC. For both pathogens, co-infections were more common in culture negative/PCR positive samples than in culture positive samples. Clinical characteristics differed significantly in and between groups. Campylobacter culture positive patients had very high prevalence of characteristics of acute infectious gastroenteritis, whereas patients with PCR positive test results only often had an alternative explanation for their diarrhoea. Culture positives were almost exclusively C. jejuni/coli, whereas in culture negatives, constituting a third of the total PCR positives, C. concisus was the most frequent species. The vast majority of EPEC only positives had documented non-infectious factors that could explain diarrhoea. The EPEC co-infected group mimicked the culture positive campylobacter group, with most patients fulfilling the infectious gastroenteritis criteria. Conclusions In hospitalised patients, positive PCR results for campylobacter and EPEC should be interpreted in a clinical context after evaluation of non-infectious diarrhoea associated conditions, and cannot be used as a stand-alone diagnostic tool.

• Morland, Mona; Haagensen, Rolf E; Dahl, Fredrik Andreas & Berdal, Jan Erik (2018). Epidemiologi og prognoser i en medisinsk overvåkningsavdeling. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(8), s. 734–739. doi: 10.4045/tidsskr.17.0496. Fulltekst i vitenarkiv
• Albotins, Craig A.; Berdal, Jan Erik; Cascas, Fransisco; Corona, Pablo S.; Cuellar, Daniel & Ferrari, Matteo Carlo [Vis alle 15 forfattere av denne artikkelen] (2018). Hip and Knee Section, Prevention, Antimicrobials (Systemic): Proceedings of International Consensus on Orthopedic Infections. Journal of Arthroplasty. ISSN 0883-5403. 34(2), s. S279–S288. doi: 10.1016/j.arth.2018.09.012. Fulltekst i vitenarkiv
• Mohn, Kristin Greve Isdahl; Cox, Rebecca Jane; Tunheim, Gro; Berdal, Jan Erik; Hauge, Anna G & Jul-Larsen, Åsne [Vis alle 10 forfattere av denne artikkelen] (2015). Immune responses in acute and convalescent patients with mild, moderate and severe disease during the 2009 influenza pandemic in Norway. PLOS ONE. 10:e0143281(11). doi: 10.1371/journal.pone.0143281. Fulltekst i vitenarkiv Vis sammendrag

  Increased understanding of immune responses influencing clinical severity during pandemic influenza infection is important for improved treatment and vaccine development. In this study we recruited 46 adult patients during the 2009 influenza pandemic and characterized humoral and cellular immune responses. Those included were either acute hospitalized or convalescent patients with different disease severities (mild, moderate or severe). In general, protective antibody responses increased with enhanced disease severity. In the acute patients, we found higher levels of TNF-α single-producing CD4+T-cells in the severely ill as compared to patients with moderate disease. Stimulation of peripheral blood mononuclear cells (PBMC) from a subset of acute patients with peptide T-cell epitopes showed significantly lower frequencies of influenza specific CD8+ compared with CD4+ IFN-γ T-cells in acute patients. Both T-cell subsets were predominantly directed against the envelope antigens (HA and NA). However, in the convalescent patients we found high levels of both CD4+ and CD8+ T-cells directed against conserved core antigens (NP, PA, PB, and M). The results indicate that the antigen targets recognized by the T-cell subsets may vary according to the phase of infection. The apparent low levels of cross-reactive CD8+ T-cells cells recognizing internal antigens in acute hospitalized patients suggest an important role for this T-cell subset in protective immunity against influenza. I

• Berdal, Jan Erik; Haagensen, Rolf E; Ranheim, Trond Egil & Bjørnholt, Jørgen (2014). Nosocomial candidemia; risk factors and prognosis revisited; 11 years experience from a Norwegian secondary hospital. PLOS ONE. 9(7). doi: 10.1371/journal.pone.0103916. Fulltekst i vitenarkiv
• Berdal, Jan Erik; Mollnes, Tom Eirik; Wæhre, Torgun; Olstad, Ole Kristoffer; Halvorsen, Bente & Ueland, Thor [Vis alle 12 forfattere av denne artikkelen] (2011). Excessive innate immune response and mutant D222G/N in severe A (H1N1) pandemic influenza. Journal of Infection. ISSN 0163-4453. 63(4), s. 308–316. doi: 10.1016/j.jinf.2011.07.004. Fulltekst i vitenarkiv
• Berdal, Jan Erik; Stavem, Knut; Omland, Torbjørn; Hall, Christian & Smith, Erichsen Nils (2008). Prognostic merit of N-terminal-proBNP and N-terminal-proANP in mechanically ventilated critically ill patients. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 52, s. 1265–1272. Fulltekst i vitenarkiv
• Berdal, Jan Erik; Bjørnholt, Jørgen; Blomfeldt, Anita; Smith, Erichsen Nils & Bukholm, Geir (2007). Patterns and dynamics of airway colonisation in mechanically-ventilated patients. Clinical Microbiology and Infection (CMI). ISSN 1198-743X. 13. doi: 10.1111/j.1469-0691.2006.01678.x. Fulltekst i vitenarkiv
• Berdal, Jan Erik; Smith, Erichsen Nils; Bjørnholt, Jørgen; Blomfeldt, Anita & Bukholm, Geir (2006). Does Pseudomonas aeruginosa colonization influence morbidity and mortality in the intensive care unit patient? Experience from an outbreak caused by contaminated oral swabs. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 50, s. 1095–1102. Fulltekst i vitenarkiv
• Berdal, Jan Erik; Skråmm, Inge; Mowinckel, P.; Gulbrandsen, Pål & Bjørnholt, Jørgen (2005). Use of rifampicin and ciprofloxacin combination therapy after surgical debridement in the treatment of early manifestation prosthetic joint infections. Clinical Microbiology and Infection (CMI). ISSN 1198-743X. 11, s. 843–845. Fulltekst i vitenarkiv
• Simonsen, GS; Berdal, Jan Erik; Sundsfjord, A & Berild, D (2004). Simplified and not exact about antibiotics. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 124(18), s. 2397–2397. Fulltekst i vitenarkiv
• Berdal, Jan Erik & Steinbakk, Martin (2003). Long-term antibiotic suppressive therapy for an infected thoracic aorta graft. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. s. 2260–2262. Fulltekst i vitenarkiv

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• Dahl, Tuva Børresdatter; Aftab, Friha; Prebensen, Christian Haugland; Berdal, Jan-Erik; Ueland, Thor & Barratt-Due, Andreas [Vis alle 15 forfattere av denne artikkelen] (2025). Imidazole propionate is increased in severe COVID-19 and correlates with cardiac involvement. Journal of Infection. ISSN 0163-4453. 90(6). doi: 10.1016/j.jinf.2025.106494. Fulltekst i vitenarkiv
• Juul, Frederik Emil; Bretthauer, Michael; Tonby, Kristian; Berdal, Jan-Erik; Hoff, Dag Arne Lihaug & Ofstad, Eirik Hugaas [Vis alle 27 forfattere av denne artikkelen] (2024). Fecal microbiota transplant versus Vancomycin for primary Clostridioides difficile infection - a randomized non-inferiority trial. Fulltekst i vitenarkiv
• Prebensen, Christian Haugland; Lefol, Yohan Pierre; Myhre, Peder Langeland; Lüders, Torben; Jonassen, Christine M & Blomfeldt, Anita [Vis alle 9 forfattere av denne artikkelen] (2023). Author Correction: Longitudinal whole blood transcriptomic analysis characterizes neutrophil activation and interferon signaling in moderate and severe COVID-19 (Scientific Reports, (2023), 13, 1, (10368), 10.1038/s41598-023-37606-y). Scientific Reports. 13(1). doi: 10.1038/s41598-023-39872-2. Fulltekst i vitenarkiv
• Lyngbakken, Magnus; Berdal, Jan Erik; Eskesen, Arne N; Kvale, Dag; Christoffer, Olsen Inge & Rangberg, Anbjørg [Vis alle 10 forfattere av denne artikkelen] (2020). Norwegian Coronavirus Disease 2019 (NO COVID-19) Pragmatic Open label Study to assess early use of hydroxychloroquine sulphate in moderately severe hospitalised patients with coronavirus disease 2019: A structured summary of a study protocol for a randomised controlled trial. Trials. 21. doi: 10.1186/s13063-020-04420-0. Fulltekst i vitenarkiv
• Berdal, Jan Erik (2020). Management of Extracranial infections. I Sundstrøm, Terje; Grände, Per-Olof; Luoto, Teemu; Rosenlund, Christina; Undén, Johan & Wester, Knut Gustav (Red.), Management of Severe Traumatic Brain Injury Evidence, Tricks, and Pitfalls. Springer. ISSN 9783030393830. s. 485–491. doi: 10.1007/978-3-030-39383-0. Fulltekst i vitenarkiv
• Berdal, Jan Erik (2017). Infeksjonmedisin. Klinisk undersøkelse og utredning, Indremedisin I & II. Forlaget Vett & Viten AS. ISSN 9788241207402. s. 15–23. Fulltekst i vitenarkiv
• Simonsen, Gunnar Skov; Berdal, Jan-Erik; Grave, Kari; Juvet, Lene Kristine; Lunestad, Bjørn Tore & Riisberg, Ingvild [Vis alle 9 forfattere av denne artikkelen] (2020). Antibiotikaresistens - Kunnskapshull, utfordringer og aktuelle tiltak. Status 2020. Folkehelseinstituttet. ISSN 9788284061535. Fulltekst i vitenarkiv Vis sammendrag

  Antimikrobiell resistens (AMR) er en global trussel mot helse og velferd hos mennesker og dyr. Den grunnleggende forståelsen av AMR har ikke endret seg over det siste tiåret, men vi har fått mer detaljert innsikt i hvordan resistens oppstår, selekteres og kan spre seg innad hos og mellom mennesker, dyr og i miljøet. Det er nødvendig å se utfordringene knyttet til AMR i et helhetlig Én helse - perspektiv. Den overordnede strategiske utfordringen på tvers av sektorer er hvordan Norge kan opprettholde sin gode nasjonale AMR-status hos mennesker og dyr, samt for mat. I tråd med føre-var-prinsippet er det viktig å begrense utvikling og spredningen av AMR gjennom målrettede tiltak mot dokumenterte drivere av AMR-utviklingen. De sentrale tiltakene vil fortsatt være knyttet til å redusere behovet for antibiotika, øke treffsikkerheten ved antibiotikaforskrivning og hindre spredning av resistente bakterier. Vi har imidlertid ikke nok kunnskap om hvordan vi skal oppnå dette på en best mulig måte.

• Berdal, Jan Erik; Bukholm, Geir; Jonassen, Christine M & Müller, Fredrik (2012). Airway colonization, pathogenesis and prognosis in mechanically ventilated patients. Universitetet i Oslo. Fulltekst i vitenarkiv

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