What Blocks Better Antibiotic Use for Suspected UTIs in Aged Care Homes

The review followed JBI guidelines and was reported in accordance with PRISMA 2020. The researchers searched five databases from inception to 12 February 2026, identifying 1130 records through database searches, supplemented by citation and trial registry searches. Studies were eligible if they explicitly reported barriers and/or enablers to implementing antimicrobial stewardship strategies for suspected urinary tract infections in residential aged care homes. Two reviewers independently screened the studies, extracted data and assessed methodological quality using the Mixed Methods Appraisal Tool, before synthesising the findings inductively and mapping them to the Theoretical Domain Framework.

Twelve studies met the inclusion criteria. The barriers reported across these studies clustered around several recurring themes: workforce instability and limited resources, reliance on established practice, social pressure from clinicians and families, gaps in staff knowledge and confidence, concerns about negative consequences, and limited stakeholder engagement.

Against these obstacles, the review identified a consistent set of enablers. Staff education and training, multidisciplinary collaboration, access to clinical decision-support tools, leadership support, and organisational policy alignment were the key facilitators reported. The authors conclude that antimicrobial stewardship implementation for suspected urinary tract infection in residential aged care homes is influenced by multiple contextual and behavioural determinants, and that addressing resource constraints, social pressure, beliefs about consequences and knowledge gaps, while reinforcing education, leadership support and policy alignment, may facilitate more effective and sustainable implementation.

As the authors note, the review synthesised reported barriers and enablers from the included studies, with methodological quality assessed using the MMAT. Environmental Context and Resources, Social Influences, and Behavioural Regulation were among the most commonly represented TDF domains across the included studies.

Subject of Research: Barriers and enablers to antimicrobial stewardship for suspected urinary tract infections in residential aged care

Article Title: Barriers and enablers to implementing antimicrobial stewardship for suspected urinary tract infection in residential aged care: a systematic review

Article References: Chand, S., Dent, E., Morgan, M., & Jones, C. (2026). Barriers and enablers to implementing antimicrobial stewardship for suspected urinary tract infection in residential aged care: a systematic review. Aging Clinical and Experimental Research. https://doi.org/10.1007/s40520-026-03551-9

Image Credits: AI Generated

DOI: 10.1007/s40520-026-03551-9

Keywords: antimicrobial stewardship, urinary tract infection, residential aged care, systematic review, Theoretical Domain Framework, implementation science, antibiotic prescribing, aged care homes, behavioural determinants, nursing homes, Barriers, enablers