Factors influencing antibiotic prescriptions in nursing homes in a French region: an observational study

Antibiotics are among the most frequently prescribed drug classes in nursing homes, yet more than 50% of prescriptions are inappropriate. This study aimed to identify structural and functional factors associated with the variability in antibiotic prescribing across nursing homes. We conducted a cross-sectional observational study using antibiotic consumption data from nursing homes in the French Auvergne–Rhône-Alpes region in 2023. Antibiotic use was quantified as defined daily doses (DDDs) per 1,000 resident-days. Data were obtained from the National Health Insurance administrative database, which records all reimbursed healthcare services. A total of 655 nursing homes, representing approximately 51,200 residents of the Auvergne–Rhône-Alpes region, were included. Antibiotic consumption was lower in facilities supported by a multidisciplinary antibiotic team (35.9 vs 39.1 DDD per 1,000 resident-days; P < .001) and in those with social assistance accreditation (36.3 vs 43.2 DDD per 1,000 resident-days; P < .001). In contrast, antibiotic consumption increased significantly with higher general practitioner density and greater resident care intensity. No significant associations were observed with facility capacity, the funding model, the presence of a coordinating physician, or ownership status (public, private for-profit, or private nonprofit). Antibiotic use in nursing homes is associated with several institutional and structural characteristics. Support from a local multidisciplinary antibiotic team was associated with lower antibiotic consumption. These findings underscore the importance of antimicrobial stewardship programs grounded in close collaboration between infectious disease specialists and nursing home healthcare professionals.