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.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Hanna Jarva, University of Helsinki, Finland
- Second opponent: Professor Lars Heggelund, University of Bergen
- Third member and chair of the evaluation committee: Associate Professor Per Medbøe Thorsby, University of Oslo
Chair of the Defence
Associate Professor Kirsten Midttun Gravningen, University of Oslo
Principal Supervisor
Associate Professor Susanne Dudman, University of Oslo
Summary
Respiratory infections are common, and adults experience one or more infections yearly. Most of the infections are viral, yet the amount of antibiotics prescribed to these patients is considerable. This is of great concern, in the light of the antimicrobial resistance crisis.
The aims of this thesis were to investigate the etiology, severity, outcome and antibiotic consumption in hospitalized adults with viral respiratory infection. We designed a retrospective observational study, investigating adults hospitalized with viral respiratory infections in Østfold Hospital Trust.
We found a seasonal variation, with human metapneumovirus being the most common in 2015-16, influenza A in 2016-17, and finally, influenza B in 2017-18. Prior to hospitalization, 20% of the patients received antibiotic treatment. Patients with Respiratory Syncytial Virus (RSV) received prehospitalization antibiotic treatment more often (28%) than other patients.
The patients hospitalized with RSV constituted 15% of the patients, with higher National Early Warning Score (NEWS) of severity of disease, and higher inflammatory markers, than patients admitted with influenza A. Furthermore, comorbidities like COPD and congestive heart failure were more frequent in this patient group.
During hospitalization, 76% of the patients with viral respiratory infection received antibiotic treatment, despite no microbiological evidence of bacterial infection. Furthermore, 40% of these patients received an antibiotic agent in the WHO AWaRe Watch category, consisting of antibiotic agents with higher resistance driving potential. Antibiotic treatment prolonged the hospital stay, also when adjusted for age, gender and comorbidities, but was not associated with reduced mortality.
This thesis has shed light on the causes of viral respiratory infections in adults admitted to hospital and the associated disease burden, emphasizing the need for enhanced antibiotic stewardship and specific interventions, such as vaccination.
Additional information
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