Purpose <p>This study examines which signs and symptoms lead to antibiotic treatment for suspected urinary tract infections in nursing home residents across eight European countries. Understanding these factors may clarify diagnostic practices and help reduce overdiagnosis.</p> Methods <p>From February to April 2024, nursing home staff in Denmark, Greece, Hungary, Lithuania, Poland, Slovakia, Slovenia, and Spain completed a registration chart for each resident treated with antibiotics. The chart collected data on treatment indication, risk factors for urinary tract infection, and signs and symptoms attributed to the infection. Descriptive analysis was conducted to examine variation in signs and symptoms attributed to urinary tract infections across countries.</p> Results <p>This study included 9718 residents across 109 nursing homes. During the study period, 975 antibiotic treatments were initiated on suspicion of urinary tract infection in residents without an indwelling urinary catheter. The median age of residents receiving treatment was 86&#xa0;years, and 76% were women. Substantial variation was observed in the signs and symptoms attributed to urinary tract infections. In some countries, general symptoms, such as changes in behavior and confusion, predominated; in others, urinary tract symptoms were more common; while in others, changes in urine were most frequently reported.</p> Conclusions <p>The marked variation in signs and symptoms attributed to urinary tract infections across countries highlights both the diagnostic complexity and the lack of consensus regarding diagnostic approaches in nursing home settings. This uncertainty may contribute to overdiagnosis and inappropriate antibiotic prescribing. Greater standardization and improved diagnostic guidance are warranted.</p>