ArticleFrontiers in medicine2026
Inappropriate urine culture testing in nursing home residents: a driver of antibiotic overtreatment and antimicrobial resistance.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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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