A scoping review of urinary tract infection management in residential aged care settings

Urinary tract infections (UTI) are the most prevalent health care associated infection in residential aged care homes (RACH), affecting 23.6% of older people in any settings. Management strategies vary significantly. This scoping review evaluates best practice UTI management in RACHs over the last 13 years.

A systematic search of Medline, CINAHL, and Embase was conducted to identify studies reporting UTI management using current diagnostics criteria. Studies published between January 2013 to January 2026 were included.

Of 1,112 studies identified, 33 met inclusion criteria. Studies were categorized by outcome with 9 evaluating UTI interventions and measuring UTI rates, 10 measuring diagnostic accuracy and 19 reporting antimicrobial prescribing and several reporting multiple outcomes.

Multifaceted UTI management programs including antimicrobial stewardship and a combination of staff education, guidelines, decision-support tools and use of change champions effectively reduced UTI rates. Diagnostic inconsistencies exist when applying McGeer surveillance criteria, Loeb's minimum criteria, and specific organizational criteria potentially resulting in inappropriate antimicrobial prescribing.

A standardized, validated UTI definition is needed to improve diagnostic accuracy and support antimicrobial stewardship for older populations. Further, multifaceted programs are effective but additional research is warranted to evaluate the full impact of interventions and aspects that work.