Diagnosing urinary tract infections Progress in nursing homes

Urinary tract infections (UTIs) are the main reason for prescribing antibiotics in nursing homes, however, most prescriptions are unnecessary. Diagnostic uncertainty is an important contributor to overdiagnosis and overtreatment of presumed UTIs in nursing home residents. Antibiotic overuse contributes to the development of antimicrobial resistance (AMR). Improving the diagnosis of UTIs in nursing homes is therefore needed to better inform treatment decisions. This thesis describes strategies to improve UTI diagnosis. The focus of the research described in this thesis ranges from the value of (non-specific) symptomatology and the use of clinical guidelines to guide clinical decision making, to the challenges of urine specimen collection and the evaluation of rapid diagnostic methods for UTI diagnosis and bacterial susceptibility testing.