(P-351) COVID-19 Treatment Approaches Among Hospitalized Patients in a National Healthcare System

Background: Since its emergence in late 2019, the novel coronavirus (SARS-CoV-2) has resulted in over 106 million cases of COVID-19, 2 million deaths, and significant burden to healthcare systems and economies worldwide. Knowledge of the disease has evolved and has thus impacted COVID-19 treatment approaches.

Objectives: To review COVID-19 treatments and antibiotic use among hospitalized patients and changes in treatments over the course of the COVID-19 pandemic in the national Veterans Affairs (VA) healthcare system.

Methods: We included hospitalized Veterans with a positive COVID-19 PCR test in our retrospective cohort study. The index date was defined as the date of the first positive COVID-19 PCR test or admission date, whichever came first. The admission date was the date of first positive COVID-19 PCR test for 57.7% of Veterans. Index dates occurring through Nov 30, 2020 were included. We assessed the utilization of COVID-19 treatments (per the U.S. National Institute of Health’s COVID-19 Treatment Guidelines) and antibiotics among this cohort. We stratified treatments temporally by index date quarter (Q1 Mar, Q2 Apr-Jun, Q3 Jul-Sept, Q4 Oct-Nov).

Results: Our study included 16,551 patients, with a mean age of 68.8 years (sd 13.5) and were mostly male (94.9%) and white (58.8%, black 32.3%). Over the entire study period, dexamethasone was utilized most frequently (43.8%), followed by remdesivir (36.1%), and hydroxycholorquine (8.1%). Use of dexamethasone and remdesivir increased in Q4 to 63.4% and 53.5% respectively, while hydroxycholorquine utilization peaked in Q1 (54.4%) and decreased markedly by Q3 (0.8%) and Q4 (0.7%). Use of janus kinase inhibitors (0.2%) and IL-6 inhibitors (2.7%) was minimal and decreased over the study period. The most common antibiotics given to our cohort were azithromycin (28.1%), ceftriaxone (22.7%), and vancomycin (12.9%). There were notable decreases in broad spectrum antibiotic use from Q1 to Q4 (piperacillin-tazobactam 16.8% vs 4.1%; cefepime/metronidazole 22% vs 4.7%; vancomycin 31.2% vs 5.5%). Azithromycin use peaked in Q1 (59.0%) and decreased by the end of the year (Q3, 25.3%; Q4, 22.6%).

Conclusions: In hospitalized patients with COVID-19 disease, treatment patterns trends aligned temporally with emerging guideline recommendations. While broad-spectrum and overall antibiotic use decreased over the study period, antibiotics remained one of the most commonly prescribed medication classes in COVID-19 patients. Given the low incidence of bacterial co-infection reported in the literature for COVID-19 patients, future studies elucidating the appropriateness of antibiotic use in this population are warranted.