(294) Urinary tract infection diagnosis and management in eight European countries: Results of a context analysis study.

Background: Excessive and inappropriate use of antibiotics is the main driver of antimicrobial resistance, which is particularly problematic, especially in frail older people who are susceptible to frequent and severe infections. A lack of infection prevention and control and inappropriate diagnosis leads to antimicrobial overprescribing in nursing homes.

Objectives: This study aimed to assess how the urinary tract infections (UTI) are diagnosed and managed among nursing home residents in eight countries: Denmark, Greece, Hungary, Lithuania, Poland, Spain, Slovakia, and Slovenia. The participants were nursing home staff working directly with the daily care of the residents.

Methods: A survey was conducted between March and May 2023 to identify areas for improvement in infection prevention and antibiotic stewardship in nursing homes. A questionnaire comprising 19 questions was developed and administered. The present study is referred to the questions related the infection diagnosis and management in residents both with and without urinary indwelling catheters.

Results: A total of 286 participants from the eight countries completed the online questionnaire. Among staff who suspect a UTI, the majority (76.2%) inquire about residents' symptoms, 72.7% consult a doctor, 57.7% perform a urine dipstick test, 56.6% focus on improving infection prevention measures, and 49.3% collect a urine sample for culture. Only a small percentage (11.9%) directly administer antibiotics, while 30.8% rule out other possible diagnoses before proceeding with treatment. Only 28% of the nursing homes have written guidelines for appropriate antimicrobial use and in 30% of the cases prophylactic use for UTIs is common. When asked if antimicrobial resistance was a problem in the nursing homes, 13% didn’t know, 39% considered it was a minor or nonexistent problem, 37% to some extent and only in 12% of the cases it was considered important.

Conclusions: Based on these findings, there's clear potential for improvement in how UTIs are diagnosed and managed within nursing homes.