To identify whether differences in antibiotic prescribing practices by prescriber type and specialization in nursing home (NH) care exist for urinary tract infection (UTI) and pneumonia. Retrospective cohort. This national study included antibiotic dispensings to traditional Medicare beneficiaries aged ≥65 years with UTI or pneumonia infections residing long-term (≥100 days) in US NHs between 2016 and 2018. Minimum Data Set assessment data were linked to Medicare data [Part D prescription drug, inpatient hospital (MedPAR), prescriber characteristics, and enrollment]. We compared antibiotic prescribing patterns by prescriber type [physician vs advanced practice practitioner (AP)] and NH specialization (≥90% vs <90% of all associated medication dispensings to NH residents). Antibiotic dispensing measures included the total number of dispensings and duration of therapy (median number of days supplied) by antibiotic class. There were 264,735 antibiotic dispensings prescribed by 32,437 prescribers for 140,360 residents in 14,035 NHs. NH specialists were less likely to prescribe fluoroquinolones for UTI (22.9% NH specialist physician, 23.9% non-NH specialist physician, 21.3% NH specialist AP, 24.2% non-NH specialist AP), but more likely to prescribe fluoroquinolones for pneumonia (38.9%, 37.8%, 38.8%, 37.3%, respectively). Over time, NH specialists reduced fluoroquinolone prescribing for pneumonia to a greater extent than non-NH specialists. The duration of therapy was similar across prescriber groups for UTI, but longer among non-NH specialist APs for several antibiotic classes for pneumonia, including tetracyclines, glycopeptides and lipoglycopeptides, and metronidazole. There were differences in antibiotic prescribing patterns by prescriber type and specialization in NH care between 2016 and 2018. Understanding how antibiotic prescribing differs based on prescriber characteristics is essential to inform antibiotic stewardship efforts. Tailoring antibiotic stewardship efforts to prescribers by NH specialization is rational given differences in antibiotic prescribing patterns based on NH specialization.

中文翻译：

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2016-2018 年疗养院护理中按处方者类型和专业划分的尿路感染和肺炎抗生素处方模式

旨在确定疗养院 (NH) 护理中不同处方者类型和专业化对尿路感染 (UTI) 和肺炎的抗生素处方实践是否存在差异。回顾性队列。这项全国性研究包括对 2016 年至 2018 年间在美国 NH 长期居住（≥100 天）、年龄≥65 岁、患有尿路感染或肺炎感染的传统医疗保险受益人的抗生素配药情况。最小数据集评估数据与医疗保险数据[D 部分处方]相关联。药物、住院医院 (MedPAR)、处方者特征和入组]。我们按处方者类型[医师与高级执业医师 (AP)] 和 NH 专业化（向 NH 居民发放的所有相关药物的 ≥90% 与 <90%）比较了抗生素处方模式。抗生素配药指标包括按抗生素类别分列的配药总数和治疗持续时间（中位供应天数）。 32,437 名处方者为 14,035 个NH 的 140,360 名居民开了 264,735 份抗生素处方。新罕布什尔州专科医生不太可能为 UTI 开氟喹诺酮类药物（22.9% 新罕布什尔州专科医生、23.9% 非新罕布什尔州专科医生、21.3% 新罕布什尔州专科医生 AP、24.2% 非新罕布什尔州专科医生 AP），但更有可能为肺炎开氟喹诺酮类药物（38.9%）分别为 %、37.8%、38.8%、37.3%）。随着时间的推移，新罕布什尔州专家比非新罕布什尔州专家更大程度地减少了治疗肺炎的氟喹诺酮类药物。各尿路感染处方者组的治疗持续时间相似，但非 NH 专科 AP 中多种肺炎抗生素（包括四环素、糖肽和脂糖肽以及甲硝唑）的治疗持续时间更长。 2016 年至 2018 年，不同处方者类型和 NH 护理专业化的抗生素处方模式存在差异。了解抗生素处方如何根据处方者特征而有所不同，对于为抗生素管理工作提供信息至关重要。鉴于基于 NH 专业化的抗生素处方模式存在差异，通过 NH 专业化为处方者定制抗生素管理工作是合理的。