Table 4.

Description of How Nonconsensus^* Items after the Fourth Round Delphi Questionnaire Were Processed by the Research Team in the Adjusted Version of the Decision Tool for the Empiric Treatment of UTI in Frail Older Adults

Nonconsensus Items	Decision	Rationale
Should antibiotics be prescribed if there was one very bothersome of the following recent-onset of S&S: dysuria, urgency, frequency, incontinence, (visible) urethral purulence?	Antibiotics should be only prescribed if there is no other cause	The majority (57%) of panel members would prescribe antibiotics in case of one very bothersome of these S&S, 64% if also an expert is considered who would only prescribe if no other cause could be found.
Should there be a minimum of 2 or 3 urinary tract related S&S to proceed to antibiotic prescribing?	A minimum of 2 urinary tract related S&S justifies antibiotic prescribing	The majority (71%) of panel members would prescribe antibiotics in case of 2 urinary tract related S&S, 93% if also the experts that would conditionally prescribe are considered (the conditions being moderate or severe signs and symptoms).
Should costovertebral angle pain/tenderness result in antibiotic prescribing if combined with systemic S&S?	Costovertebral angle pain/tenderness combined with systemic S&S justifies antibiotic prescribing	The majority (71%) of panel members would prescribe antibiotics in case of costovertebral angle pain/tenderness combined with systemic S&S, 78% if also an expert is considered who would prescribe if the systemic S&S would include fever with hypotension and tachycardia.
Should suprapubic pain result in antibiotic prescribing if combined with systemic S&S?	Suprapubic pain combined with systemic S&S does not justify antibiotic prescribing	The majority (57%) of panel members would not prescribe antibiotics for possible UTI in case of suprapubic pain combined with systemic S&S. Four experts pointed at the non-specific nature of suprapubic pain and the importance of evaluating for other causes (which could be a different infectious source justifying antibiotic prescribing).
Should antibiotics be prescribed in case of urinary retention combined with one or more of the following recent-onset S&S: dysuria, urgency, frequency, incontinence, (visible) urethral purulence?	Antibiotics should be prescribed in case there are 2 or more localizing S&S or one very bothersome localizing S&S with no other cause	The listed urinary tract related S&S should be guiding here, not the urinary retention, so decisions on antibiotic prescribing for those S&S e resulting from the Delphi procedure – apply here.
Should urinary tract related S&S relevant in evaluating a possible UTI be defined as “new” or “new/significantly increased”?	Only “new” urinary tract related S&S are considered in evaluating a possible UTI, rephrased as “of recent onset”	The majority (57%) of panel members had a preference for “new” over “new/significantly increased.” In addition, 3-panel members commented that the term “significantly increased” is ambiguous (i.e., can differ between persons).

^*Consensus was defined as an agreement level of _75%.²⁰