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Urinary Tract Infections Management · Journal article
Frontiers in Medicine · August 17, 2026
Early or partial results. Treat as a signal, not a conclusion.
This retrospective observational study of 102 nursing home residents found that inappropriate urine testing and antibiotic prescribing were frequent, with 42.5% of prescriptions classified as inappropriate by French infectious disease society criteria and 51.7% of positive cultures yielding ESBL-producing organisms. The findings highlight diagnostic difficulty in distinguishing symptomatic UTI from asymptomatic bacteriuria in older adults with non-specific symptoms, but the uncontrolled design does not establish that stewardship interventions would reduce harm.
Retrospective observational study. Nursing home residents evaluated for suspected UTI; mean age 83.0 ± 8.3 years, 69.6% female. Non-specific geriatric manifestations were common, making clinical diagnosis difficult.. Intervention: None; observational study of existing testing and prescribing practices. n = 102. Two French nursing homes.
Urine dipstick testing performed in 95 of 102 residents (93.1%), positive in 87 (91.6%) Urine cultures performed in 87 residents; 60 (69.0%) had positive cultures ESBL-producing Enterobacterales identified in 31 of 60 positive cultures (51.7%)
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians in long-term care should recognise that positive urine cultures and dipstick results do not alone justify antibiotic treatment, particularly when non-specific geriatric symptoms predominate. Implementation of diagnostic stewardship criteria based on clinical rather than microbiological evidence may reduce inappropriate exposure to broad-spectrum antibiotics and limit selection for resistance, but this study does not quantify the benefit of such interventions.
Single-centre retrospective observational study of modest size without comparator, describing testing and prescribing practices; generates actionable findings about stewardship but lacks the design or sample size to confirm causation or quantify intervention benefit.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians in long-term care should recognise that positive urine cultures and dipstick results do not alone justify antibiotic treatment, particularly when non-specific geriatric symptoms predominate. Implementation of diagnostic stewardship criteria based on clinical rather than microbiological evidence may reduce inappropriate exposure to broad-spectrum antibiotics and limit selection for resistance, but this study does not quantify the benefit of such interventions.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background Inappropriate urine testing and antibiotic prescribing are common challenges in nursing home residents evaluated for suspected urinary tract infection (UTI). This study evaluated urine testing practices, microbiological findings, and antibiotic prescribing in two French nursing homes. Methods We conducted a retrospective observational study of 102 nursing home residents evaluated for suspected UTI between June 2024 and April 2026. Demographic, clinical, microbiological, and therapeutic data were retrospectively collected. Antibiotic prescriptions were assessed according to French Infectious Diseases Society (SPILF) criteria. Descriptive analyses were performed. Results The mean age was 83.0 ± 8.3 years, and 71 (69.6%) residents were women. Urine dipstick testing was performed in 95 (93.1%) residents and was positive in 87 (91.6%). Urine cultures were performed in 87 residents, of whom 60 (69.0%) had positive cultures. ESBL-producing Enterobacterales were identified in 31 (51.7%) positive urine cultures. Twenty-seven residents received empirical antibiotics despite a subsequently negative urine culture, and 42.5% of antibiotic prescriptions were classified as inappropriate according to SPILF criteria. Fosfomycin was the most frequently prescribed antibiotic. Non-specific geriatric manifestations were common, highlighting the diagnostic difficulty of distinguishing symptomatic UTI from asymptomatic bacteriuria. Conclusion Inappropriate urine testing and antibiotic prescribing were frequent in this nursing home population. Positive urine cultures, including those yielding ESBL-producing organisms, should not be interpreted in isolation as evidence of symptomatic infection or an indication for antibiotic therapy. Strengthening diagnostic stewardship and adherence to clinical criteria may reduce unnecessary urine testing and antimicrobial exposure while promoting appropriate antibiotic use.
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