Objectives: Studies have found an inverse relationship between community influenza vaccination rates and antibiotic use. This study examined the relationship between community-level influenza vaccination rates and facility-level antibiotic use in US nursing homes. We hypothesized that nursing homes in counties with high influenza vaccination rates would have low antibiotic prescribing rates.
Methods: We linked data from the Centers for Medicare & Medicaid Services for adults aged ≥65 years in US nursing homes in 2019 at individual, facility, and county levels. We used linear mixed models to examine the association between county-level influenza vaccination rates and facility-level antibiotic prescribing rates. We generated maps to illustrate the overlap of facilities by quartiles of antibiotic prescribing and county-level influenza vaccination rates across the United States.
Results: A 1% increase in county influenza vaccination rates was associated with a 0.03% decrease in the nursing home antibiotic prescribing rate after controlling for other factors (ß = -0.03; 95% CI, -0.03 to -0.02). As compared with other regions, the Midwest had a larger concentration of nursing homes in the upper quartile for antibiotic prescribing rates. When compared with nursing homes in the Midwest, nursing homes in the Northeast (ß = -0.98; 95% CI, -1.12 to -0.83), South (ß = -1.84; 95% CI, -1.95 to -1.73), and West (ß = -4.60; 95% CI, -4.79 to -4.41) showed a decrease in antibiotic prescribing rates.
Conclusions: Modest improvements in community-level influenza vaccination rates can lead to decreased antibiotic prescribing rates in nursing homes.
Keywords: antibiotic use; influenza vaccinations; nursing home.