By David Wild
After an initial spike in antibiotic prescribing at Veterans Affairs’ centers during the COVID-19 pandemic, use of antibiotics has returned to pre-pandemic levels in these settings, according to research presented at ID-Week 2021 (poster 170).
The results indicate that antibiotic stewardship efforts are ongoing and continue to be effective, according to lead researcher Matt Goetz, MD, the chief of infectious diseases at the VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at University of California, Los Angeles.
“In our previously published work, we demonstrated that antibiotic use in the VA increased by 11% in the first five months of 2020, largely reversing declines in VA antimicrobial utilization that had occurred since 2015,” Dr. Goetz said during a virtual presentation. “We wanted to see whether these changes persisted throughout the COVID-19 pandemic.”
To that end, Dr. Goetz and his team analyzed data on antimicrobial use in acute inpatient care units at 108 level 1 VA facilities and two other VA facilities between January 2020 and February 2021. They included COVID-19 and non–COVID-19 patients. A level 1 unit cares for the most complex, high-risk patients.
Monthly total acute care antibiotic use increased from a low of 533 days of treatment per 1,000 patient care days in January 2020 to 583 days of treatment per 1,000 days of care in April 2020. After that initial rise, antibiotic use declined to 495 days of treatment per 1,000 days of care in September 2020 and remained at pre-pandemic levels subsequently, with less than 500 days of treatment per 1,000 days of care in February 2021.
“This decrease was despite rises in COVID-19 care, which accounted for 24% of all patient care in January 2021,” Dr. Goetz noted.
When they analyzed antibiotic use patterns by COVID-19 and non–COVID-19 patients, they found antibi-otic use decreased from a high of 550 days of treatment per 1,000 days of care during the early phase of the pandemic for non–COVID-19 patients to 509 days of treatment per 1,000 days of care between November 2020 and February 2021 for this group. Similarly, antibiotic use among COVID-19 patients dropped from a peak of 590 days of treatment per 1,000 days of care in the early phase of the pandemic to 528 days of treat-ment per 1,000 days of care between November 2020 and February 2021.
“Although the degree to which the initial increase in antibiotic use is attributable to concerns of bacterial superinfection versus changes in case mix—for example, decreased elective admission—remains to be as-sessed, these data support the continued effectiveness of antimicrobial stewardship programs in the VA,” Dr. Goetz concluded.
