When COVID-19 Hit, Antibiotic Use in VA Hospitals Spiked Up

VA hospitals used more antibiotics in the first 5 months of 2020, which reversed declines in antibiotic use in recent years, a researcher said.

Days of therapy per 1,000 days present rose to 631 in January-May 2020, the highest since 2016 when it was 630 days per 1,000, reported Matthew Goetz, MD, of VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at the University of California Los Angeles.

“We’ve lost about 3 years of progress,” said Goetz at a press conference at the virtual IDWeek.

However, increased use had no correlation with COVID-19 case burden. In fact, Goetz noted “tremendous variation across sites,” with some facilities with a large number of COVID cases noting little change, and some with relatively few cases seeing an increase.

Goetz attributed the overuse early on in the pandemic to “diagnostic confusion” when a patient presented with respiratory distress or pneumonia.

Given COVID-19 often presents as a respiratory illness, and patients developing pneumonia was reported early in the pandemic, he told MedPage Today that while they did not present the data as broken out by month, the peak antibiotic use was “sometime in March or April” and “in May, antibiotic use may have been decreasing” as the medical community learned more about the virus.

“We didn’t have testing available, and didn’t have enough information [about] other treatments,” he added, speculating that, “as physicians became more comfortable” with diagnosing COVID-19 and had “less reliance on antibiotics, that’s why rates came down.”

Researchers examined data from 84 VA facilities in the U.S. from January 1-May 31 for 2015-2020. CDC National Healthcare Safety Network Antimicrobial Use rules determined days of therapy per 1,000 days-present. COVID days of care were defined as all acute days of care after laboratory confirmation of infection.

After hitting 605 days of therapy per 1,000 in 2019, this number shot up to 631 days of therapy per 1,000 in 2020. The largest increases were among community-acquired pneumonia agents and broad-spectrum agents for gram-resistant negative bacteria. Use of all CDC antibiotic classes rose in 2020, except narrow-spectrum β-lactams.

Even when facilities in the hardest hit areas of the country — such as New England, New York, New Jersey, Michigan, Chicago, and New Orleans — were excluded, there was still an increase in days of therapy per 1,000 versus 2019 during that time period (638 vs 611, respectively).

At the press conference, Goetz noted if clinicians had the ability to rapidly diagnose COVID-19, then perhaps they would not have been using “antibacterial therapy, thinking a person might have bacterial pneumonia,” given there is actually low incidence of co-infection.

“With critically ill persons, we don’t want to miss bacterial causes,” he said.

Goetz described COVID-19 as a “case study” in the importance of rapid diagnostics. With the availability of rapid testing to quickly diagnose infections “we can apply the principles of precision medicine more thoughtfully to infectious disease, decrease antibiotic use, and preserve the effectiveness of what we currently have,” he noted.