Assessment of potentially unnecessary antibiotic use for suspected urinary tract infections in nursing homes using a simplified algorithm

Abstract

Background: Nursing home (NH) residents are frequently treated with antibiotics for urinary tractinfections (UTIs), often due to overdiagnosis. The aim of this study was to evaluate the proportion ofpotentially unnecessary antibiotic use for suspected UTIs in NHs across eight European countries.Research design and methods: Over a three-month period (February to April 2024), NH professionalsrecorded information on all antibiotic treatments for UTIs using a specific registration chart. Based onmedical literature and the expertise of the project consortium members, the authors developed andendorsed by consensus a simplified algorithm to assess unnecessary antibiotic use in residents withoutindwelling catheters.Results: The study, conducted across 110 NHs, included 2773 antibiotic-treated infections. Of these,1158 (41.8%) were treated for UTIs. Among 975 UTI cases without catheters, 54.1% may have beenunnecessarily treated. Over one-third involved nonspecific symptoms including poor general conditionand changes in urine appearance, while specific urinary symptoms, such as incontinence (21.3%) anddysuria (20.8%), were less common. A trend toward greater, potentially unnecessary antibiotic use wasobserved when urine dipsticks were performed.Conclusions: The findings reveal potentially unnecessary antibiotic use. Further algorithm validation isneeded to enhance diagnostic criteria, reduce overuse, and improve UTI management in NHs.