Trends in antibiotic use in long-term care hospitals during the COVID-19 pandemic: a nationwide cohort study during 2020 and 2023.

OBJECTIVE: Information regarding the use of antibiotics in long-term care hospitals (LCHs) during COVID-19 remains limited. The aim of the study was to examine the antibiotics use in Korean LCHs during the COVID-19 pandemic period. METHODS: We conducted a nationwide cohort study between 2020 and 2023. During this period, a total of 1,835,398 patients were admitted to 1,829 LCHs. RESULTS: 1,043,346 (56.9%) received antibiotics. The overall antibiotic use in LCHs was 133.33 days of therapy (DOT) per patient-days (PDs), which was lower than that observed in tertiary (933.89), secondary (798.26), and primary care hospitals (566.77). In contrast, the intensity of antibiotic use among treated patients was highest in LCHs (40.01 DOT), exceeding that in tertiary (15.22), secondary (14.60), and primary care hospitals (11.74). Antibiotic use in LCHs steadily rose from 116.18 in January 2020 to 160.65 DOT per 1000 PDs in December 2023, with a notable increase during surge of COVID-19 cases. Segmented regression analysis showed a sustained increase in antibiotic use before the Omicron wave that persisted afterward. Most statistically significant increases were observed in the use of broad-spectrum antibiotics: fourth-generation cephalosporins increased by 348.0%, carbapenems by 114.6%, and glycopeptides by 92.5%. CONCLUSIONS: During the COVID-19 pandemic, we found a significant increasing trend in antibiotic use, particularly in broad-spectrum antibiotics. These findings highlight the deed for strengthened antibiotic stewardship in LCHs during public health crises. CLINICAL TRIAL REGISTRATION: Clinical trial number: Not applicable.