181 - Antimicrobial Use in the Time of COVID-19 – Data from 84 VA Facilities

Background: The VA initiated an antimicrobial stewardship program in 2011, which includes participation in the Center for Disease Control (CDC) Antimicrobial Use Option, educational webinars, training programs for antimicrobial stewards, required staffing & reporting, and quality improvement initiatives, that has led to ongoing decreases in antimicrobial therapy nationwide.  With the onset of the COVID-19 pandemic, however, there are several factors that may contribute increases in antimicrobial use (increased presentations of lower respiratory tract infection, concern for bacterial co-infection with SARS-CoV-2, etc.).  We sought to compare patterns of antibacterial use in the VA from January – May 2020 with corresponding time periods in prior years.

Methods: Data on antibacterial use from 2015 – 2020 were extracted from the VA Corporate Data Warehouse for acute inpatient care units in 84 VA facilities (facilities which provide limited acute inpatient services were excluded).  To control for seasonal effects, only data from January to May for each year were included in the analysis. Days of therapy (DOT) per 1000 days-present (DP) were calculated and stratified by CDC-defined antibiotic classes.

Results: From 2015 – 2019, total antibiotic use from January to May decreased by a mean of 9.1 DOT/1000 DP per year.  In contrast, from 2019 to 2020, antibiotic use over the same months increased by 26.4 DOT/1000 DP (Table).  Increases were observed in all drug classes except for a decrease in narrow spectrum ß-lactam antibiotics. Total antibiotic DOT in 2020 increased by 27.9 and 7.3 DOT/1000 DP in facilities in the highest and lowest terciles of use in 2019 (Figure).Table – Trends in Yearly Antibiotic Use by CDC Drug Class, 2015 to 2019 versus 2019 to 2020
Figure – Facility Specific Total Antibiotic Use in 2019 and Change in Use from 2019 to 2020


Conclusion: We observed a broad increase in antibacterial use during the initial surge of COVID-19 cases in VA facilities that abruptly reversed steady reductions in use over the prior 4 years.  The degree to which this increase reflects potentially appropriate use in the setting of increased patient vulnerability and provider uncertainty, inappropriately decreased provider thresholds for initiating or continuing therapy, or stresses on the structure and staffing of antimicrobial stewardship programs requires further study.

Presenting Author(s)

• 

  Matthew B. Goetz, MD

  Chief, Infectious Diseases
  VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, VA-CDC Practice-Based Research Network
  Los Angeles, CA

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

  Slides Slides and Audio

Co-Author(s)

• CG

  Christopher J. Graber, MD, MPH

  Associate Clinical Professor of Medicine
  VA Greater Los Angeles Healthcare System/UCLA
  Los Angeles, California

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• MJ

  Makoto M. Jones, MD

  Assistant Professor
  IDEAS Center of Innovation, VA Salt Lake City Health Care System
  Salt Lake City, Utah

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Vanessa W. Stevens, PhD

  Research Associate Professor
  IDEAS Center of Innovation, VA Salt Lake City Health Care System
  Salt Lake City, UT

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• PG

  Peter A. Glassman, MBBS

  Professor
  VA Greater Los Angeles Healthcare System/UCLA
  Los Angeles, California

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• MR

  Michael Rubin, MD/PhD

  Professor
  IDEAS Center of Innovation, VA Salt Lake City Health Care System
  Salt Lake City, Utah

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.