{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T15:15:24Z","timestamp":1771600524402,"version":"3.50.1"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"vor","delay-in-days":44,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005416","name":"Research Council of Norway","doi-asserted-by":"publisher","award":["288718"],"award-info":[{"award-number":["288718"]}],"id":[{"id":"10.13039\/501100005416","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016190","name":"Trond Mohn Foundation","doi-asserted-by":"publisher","award":["TMS2020TMT07"],"award-info":[{"award-number":["TMS2020TMT07"]}],"id":[{"id":"10.13039\/100016190","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016190","name":"Trond Mohn Foundation","doi-asserted-by":"publisher","award":["BFS2019TMT06"],"award-info":[{"award-number":["BFS2019TMT06"]}],"id":[{"id":"10.13039\/100016190","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005036","name":"University of Bergen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005036","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010586","name":"Haukeland University Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010586","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>The MeMed BV\u00ae test distinguishes bacterial from viral infections by integrating circulating levels of TRAIL, IP-10, and CRP into a likelihood score. Pre-COVID studies reported high diagnostic accuracy in respiratory infections, but evidence in adults hospitalized with SARS-CoV-2 is sparse. To evaluate the ability of MeMed BV to identify hospitalized COVID-19 patients who could be safely managed without antibiotics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included adults with PCR-confirmed SARS-CoV-2 infection from two prospective Norwegian cohorts (October 2020\u2013April 2023). The reference standard for true viral infection was a composite safety outcome: 30-day survival, no readmission within 30\u2005days, and no antibiotic exposure before, during, or after hospitalization. MeMed BV performance was assessed using sensitivity, specificity, predictive values, and area under the ROC curve (AUC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 90 patients, 28 (31%) met the reference standard for safe antibiotic avoidance. Median MeMed BV scores were 38 (IQR 1\u201366) in the safely managed group versus 96 (IQR 78\u201399) in others (P \u200a&amp;lt;\u200a0.001). Sensitivity for identifying safe antibiotic avoidance was 50.0% (95% CI 32.6\u201367.4), specificity 88.7% (95% CI 78.5\u201394.4), PPV 66.7%, NPV 79.7%, and AUC 0.69 (95% CI 0.59\u20130.80). Patients safely managed without antibiotics misclassified as bacterial\/equivocal had markedly lower TRAIL (median 38 versus 177\u2005pg\/mL, P \u200a&amp;lt;\u200a0.001) and higher CRP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In hospitalized adults with COVID-19, MeMed BV showed reasonable specificity but limited sensitivity for identifying patients who could safely avoid antibiotics, with performance considerably lower than that observed in pre-COVID studies. These findings highlight the need for context-specific validation of host-response diagnostics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jacamr\/dlag021","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T12:32:54Z","timestamp":1770640374000},"source":"Crossref","is-referenced-by-count":0,"title":["Can a host\u2013response bacterial\u2013viral classifier safely guide antibiotic avoidance in COVID-19? A diagnostic accuracy study in hospitalized adults"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3504-8859","authenticated-orcid":false,"given":"Dagfinn Lunde","family":"Markussen","sequence":"first","affiliation":[{"name":"Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine, University of Bergen , Bergen 5020 ,","place":["Norway"]},{"name":"Department of Emergency Medicine, Haukeland University Hospital , Bergen 5021 ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina Sk\u00e5r","family":"Saghaug","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine, University of Bergen , Bergen 5020 ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siri Tandberg","family":"Knoop","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Haukeland University Hospital , Bergen 5021 ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Ritz","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine, University of Bergen , Bergen 5020 ,","place":["Norway"]},{"name":"National Institute of Public Health, University of Southern Denmark , Copenhagen ,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elling","family":"Ulvestad","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine, University of Bergen , Bergen 5020 ,","place":["Norway"]},{"name":"Department of Microbiology, Haukeland University Hospital , Bergen 5021 ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Synne","family":"Jenum","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine, University of Bergen , Bergen 5020 ,","place":["Norway"]},{"name":"Department of Infectious Diseases, Oslo University Hospital , Oslo ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harleen M S","family":"Grewal","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine, University of Bergen , Bergen 5020 ,","place":["Norway"]},{"name":"Department of Microbiology, Haukeland University Hospital , Bergen 5021 ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"2026022009354163500_dlag021-B1","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","author":"Murray","year":"2022","journal-title":"Lancet"},{"key":"2026022009354163500_dlag021-B2","doi-asserted-by":"publisher","first-page":"45","DOI":"10.3390\/antibiotics12010045","article-title":"Increasing consumption of antibiotics during the COVID-19 pandemic: implications for patient health and emerging anti-microbial resistance","volume":"12","author":"Malik","year":"2022","journal-title":"Antibiotics (Basel)"},{"key":"2026022009354163500_dlag021-B3","doi-asserted-by":"publisher","first-page":"e2511499","DOI":"10.1001\/jamanetworkopen.2025.11499","article-title":"Antibiotic treatment in 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