Clinical Reasoning Underlying Guideline Nonadherence in Urinary Tract Infections in Nursing Homes

Suspected urinary tract infections (UTIs) are the main reason for antimicrobial use in nursing homes, but prescriptions are often inappropriate, risking antimicrobial resistance development.1 Diagnosing UTIs in this population is complex because of a lack of reliable diagnostic tests to distinguish UTI from asymptomatic bacteriuria, and the frequent occurrence of nonspecific symptoms for which an association with UTI remains unclear.2 International guidelines3–5 recommend to (1) diagnose UTIs based on solely specific urinary symptoms, (2) to identify specific urinary symptoms by observation and physical examination, and (3) to prevent the use of urine dipsticks or to only use dipsticks for ruling out UTI.