Antimicrobial use before and during COVID-19: data from 108 Veterans Affairs medical centers

Objective:Inpatient antibiotic use increased during the early phases of the COVID-19 pandemic. We sought to determine whether these changes persisted in persons with and without COVID-19 infection.Design:Retrospective cohort analysis.Setting:108 Veterans Affairs (VA) facilities.Patients:Persons rece...

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Bibliographic Details
Published in:Antimicrobial stewardship & healthcare epidemiology : ASHE 2024-01, Vol.4 (1), Article e109
Main Authors: Goetz, Matthew Bidwell, Willson, Tina, Rubin, Michael A., Stevens, Vanessa W., Graber, Christopher J.
Format: Article
Language:English
Subjects:
Antibiotics
COVID-19
Data warehouses
Diabetes
Disease transmission
Drug resistance
Emergency medical care
Ethnicity
Heart failure
Hispanic Americans
Hospitalization
Intensive care
Kidney diseases
Laboratories
Length of stay
Liver diseases
Mortality
Pandemics
Patients
Staphylococcus infections
Veterans
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Summary:Objective:Inpatient antibiotic use increased during the early phases of the COVID-19 pandemic. We sought to determine whether these changes persisted in persons with and without COVID-19 infection.Design:Retrospective cohort analysis.Setting:108 Veterans Affairs (VA) facilities.Patients:Persons receiving acute inpatient care from January 2016 to October 2022.Methods:Data on antibacterial use, patient days present, and COVID-19 care were extracted from the VA Corporate Data Warehouse. Days of therapy (DOT) per 1000 days present (DP) were calculated and stratified by Centers for Disease Control and Prevention-defined antibiotic classes.Results:Antibiotic use increased from 534 DOT/1000 DP in 11/2019–2/2020 to 588 DOT/1000 DP in 3/2020–4/2020. Subsequently, antibiotic use decreased such that total DOT/1000 DP was 2% less in 2020 as a whole than in 2019. Driven by treatment for community acquired pneumonia, antibiotic use was 30% higher in persons with COVID-19 than in uninfected persons in 3/2020–4/2020, but only 4% higher for the remainder of 2020. In 2022 system-wide antibiotic use was 9% less in persons with COVID-19; however, antibiotic use remained higher in persons with COVID-19 in 25% of facilities.Discussion:Although antibiotic use increased during the early phases of the COVID-19 pandemic, overall use subsequently decreased to below previous baseline levels and, in 2022, was less in persons with COVID-19 than in persons without COVID-19. However, further work needs to be done to address variances across facilities and to determine whether current levels of antibiotic use in persons with COVID-19 are justified.
ISSN:2732-494X
2732-494X
DOI:10.1017/ash.2024.352