170. Antimicrobial Use Before and During COVID-19 – Data from 108 VA Facilities

Abstract Background Increased antibiotic prescribing rates during the early phases of the COVID-19 pandemic have been widely reported. We previously reported that while both antibiotic days of therapy (DOT) and total days present (DP) declined in the first 5 months of 2020 at Veterans Affairs (VA) acute care facilities nationwide relative to the comparable period in 2019, antibiotic DOT per 1000 DP increased by 11.3%, largely reversing declines in VA antimicrobial utilization from 2015 – 2019. We now evaluate whether these changes in antibiotic use persisted throughout the COVID-19 pandemic. Methods Data on antibacterial use, patient days present, and COVID-19 care for acute inpatient care units in 108 VA level 1 and 2 facilities were extracted through the VA Informatics and Computing Infrastructure; level 3 facilities which provide limited acute inpatient services were excluded. DOT per 1000 DP were calculated and stratified by CDC-defined antibiotic classes. Results From 1/2020 to 2/2021, care for 34,096 COVID-19 patients accounted for 13% of all acute inpatient days of care in the VA. Following the onset of COVID-19 pandemic, monthly total acute care antibiotic use increased from 533 DOT/1000 DP in 1/2020 to a peak of 583 DOT/1000 DP in 4/2020; during that month COVID-19 patients accounted for 13% of all DP (Figure). In subsequent months, total antibiotic use declined such that for the full year the change of antibiotic use from 2019 to 2020 (a decrease of 18 DOT/1000 DP) was similar to the rate of decline from 2015 to 2019 (mean decrease of 13 DOT/1000 DP; Table). The decreased DOT/1000 DP from 5/2020 to 2/2021 occurred even as the percentage of all DP due to COVID-19 peaked at 14 - 24% from 11/2020 to 2/2021. Conclusion Although rates of antibiotic use increased within the VA during the early phases of the COVID-19 pandemic, rates subsequently decreased to below previous baseline levels even as the proportion of COVID-19 DP spiked between 11/2020 and 02/2021. Although the degree to which the initial increase in antibiotic use is attributable to concerns of bacterial superinfection versus changes in case-mix (e.g., decreased elective admission) remains to be assessed, these data support the continued effectiveness of antimicrobial stewardship programs in the VA. Disclosures Matthew B. Goetz, MD, Nothing to disclose


Background. The 2019 Infectious Diseases Society of America/American
Thoracic Society community-acquired pneumonia (CAP) guidelines eliminated the term healthcare-associated pneumonia (HCAP), and recommends to guide the use of broad-spectrum antibiotics by locally validating the prevalence and risk factors of multi-drug resistant organisms (MDROs). The objective of this study is to determine the prevalence and associated patient characteristics of MDROs, and to characterize antibiotic prescribing patterns.
Methods. This was a retrospective, cohort study in adult patients hospitalized from 1/1/19 to 12/31/19. Patients were randomly selected from a patient list of diagnosis codes suggestive of pneumonia. We excluded patients with antibiotic therapy < 48 hours, bacterial co-infections from another site, or transferred from another hospital with length of stay >24 hours. Endpoints evaluated include the percentage of MDRO isolated from a respiratory or blood culture collected within 2 days of admission, comparison of patient characteristics associated with MDROs with those who did not, treatment regimen and duration, and rate of overtreatment and undertreatment.
Results. A total of 220 patients were included. Prevalence of overall MDRO, methicillin-resistant Staphylococcus aureus (MRSA), and Pseudomonas aeruginosa (PSA) was 8%, 3%, and 5%, respectively. Patient characteristics associated with MDROs from are shown in Table 1. Prior MDRO history or recent intravenous (IV) antibiotic exposure during hospitalization was present in 39% of the MDRO cohort. Over half (58%) of the patients were initiated on antibiotics with MRSA and/or PSA coverage. Rate of overtreatment and undertreatment was 89% and 5%, respectively. Mean antibiotic duration was 9 ± 3 days.

Conclusion.
The low prevalence of MDROs, coupled with the high overtreatment and low undertreatment rate suggests most patients hospitalized with CAP at our institution can receive an antibiotic regimen targeting standard CAP pathogens. Antibiotic stewardship intervention to shorten the duration of therapy should be considered. In addition to microbiology history and recent IV antibiotic exposure during hospitalization, further studies are needed to validate other patient characteristics at risk for MDROs.
Disclosures. Background. Increased antibiotic prescribing rates during the early phases of the COVID-19 pandemic have been widely reported. We previously reported that while both antibiotic days of therapy (DOT) and total days present (DP) declined in the first 5 months of 2020 at Veterans Affairs (VA) acute care facilities nationwide relative to the comparable period in 2019, antibiotic DOT per 1000 DP increased by 11.3%, largely reversing declines in VA antimicrobial utilization from 2015 -2019. We now evaluate whether these changes in antibiotic use persisted throughout the COVID-19 pandemic.
Methods. Data on antibacterial use, patient days present, and COVID-19 care for acute inpatient care units in 108 VA level 1 and 2 facilities were extracted through the VA Informatics and Computing Infrastructure; level 3 facilities which provide limited acute inpatient services were excluded. DOT per 1000 DP were calculated and stratified by CDC-defined antibiotic classes.
Results. From 1/2020 to 2/2021, care for 34,096 COVID-19 patients accounted for 13% of all acute inpatient days of care in the VA. Following the onset of COVID-19 pandemic, monthly total acute care antibiotic use increased from 533 DOT/1000 DP in 1/2020 to a peak of 583 DOT/1000 DP in 4/2020; during that month COVID-19 patients accounted for 13% of all DP (Figure). In subsequent months, total antibiotic use declined such that for the full year the change of antibiotic use from 2019 to 2020 (a decrease of 18 DOT/1000 DP) was similar to the rate of decline from 2015 to 2019 (mean decrease of 13 DOT/1000 DP; Table). The decreased DOT/1000 DP from 5/2020 to 2/2021 occurred even as the percentage of all DP due to COVID-19 peaked at 14 -24% from 11/2020 to 2/2021.

Conclusion.
Although rates of antibiotic use increased within the VA during the early phases of the COVID-19 pandemic, rates subsequently decreased to below previous baseline levels even as the proportion of COVID-19 DP spiked between 11/2020 and 02/2021. Although the degree to which the initial increase in antibiotic use is attributable to concerns of bacterial superinfection versus changes in case-mix (e.g., decreased elective admission) remains to be assessed, these data support the continued effectiveness of antimicrobial stewardship programs in the VA.
Disclosures. Matthew B. Goetz, MD, Nothing to disclose