Overdiagnosis of UTI is one of the most common reasons for unnecessary use of antibiotics in long-term care (LTC). Most residents in these settings who have a positive result on urine culture testing do not actually have a UTI but rather asymptomatic bacteriuria (ASB). Despite Choosing Wisely recommendations and international guidance that advise against this practice, 30-80% of residents with ASB receive antibiotics.

What are the barriers to change?
Urine dipsticks, which help rule out the presence of UTI in younger populations, may contribute to overdiagnosis in older patients. Staff may fear missing a UTI, or even believe that upfront treatment of ASB can prevent a UTI in the future, despite contrary evidence. These organizational and individual psychological barriers can often drive unnecessary testing and antibiotic prescriptions.

How should practice change?
In this BMJ article, Dr. Piggott and coauthors suggest targeted education supported by system changes—which include modification of order sets, routine panels, elimination of urine dipsticks and changes to laboratory processing and reporting—can be effective in changing practice.