Facility-Level Antibiotic Prescribing Rates and the Use of Antibiotics Among Nursing Home Residents.

Background: The high frequency of antibiotic use in U.S. nursing homes is a public health concern and target of antimicrobial stewardship efforts. Facility-level prescribing patterns may provide a measure for antibiotic stewardship targeting.

Methods: An analysis of 2018 and 2019 data from four linked files from the Centers for Medicaid and Medicare was conducted. Multilevel generalized linear models were used to calculate odds ratios for antibiotic receipt for calendar year 2019 using the 2018 facility prescribing rate, controlling for facility and individual-level factors.

Results: In 2019, 186,274 (19%) study residents were prescribed an antibiotic. The most frequently prescribed class of antibiotics were cephalosporins (26%) and the average duration of antibiotic use was 9 days. Residents who were dually eligible for Medicare and Medicaid had 37% increased odds of antibiotic receipt (All aOR: 1.37, 95%CI: 1.35,1.39). The 2018 facility prescribing rate was associated with 14% increased odds of antibiotic receipt in 2019 in nursing homes in the medium (11.9-20.2%) prescribing category (All aOR: 1.14, 95%CI: 1.11,1.17) and 36% increased odds of antibiotic receipt in nursing homes in the high (>20.3%) prescribing category (All aOR: 1.36, 95%CI: 1.32,1.40) when compared to the lowest (0-11.8%) prescribing category.

Conclusions: Antibiotic stewardship strategies should target nursing homes with high antibiotic prescribing rates and high populations of dually eligible patients to improve care in this population.