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Objectives Antimicrobial resistance poses a serious threat to global health, largely driven by the excessive use of antibiotics. Nursing homes play a considerable role in this problem, with residents receiving more antibiotics compared to elderly individuals living in their households. Research shows that a large share of antibiotic prescriptions in nursing homes is unnecessary, often due to overdiagnosis. This is especially true for urinary tract infections (UTIs), where diagnoses are frequently made based on unclear or unreliable criteria. Although physicians are responsible for prescribing antibiotics, the diagnostic process in nursing homes usually starts with staff members identifying a possible infection, giving them a crucial role in contributing to overdiagnosis. The purpose of this study was to assess the effect of a multifaceted intervention on reducing the proportion of potentially unnecessary antibiotic use for suspected UTIs in nursing homes across eight European countries among residents without indwelling catheters.Method This before-and-after study is part of the EU-funded IMAGINE project (https://imagineproject.eu/), which involves nursing homes across eight countries: Denmark, Greece, Hungary, Lithuania, Poland, Slovakia, Slovenia, and Spain. Over a three-month period (February to April 2024), nursing staff professionals recorded information on all antibiotic treatments for UTIs using a specific registration chart. In autumn and winter 2024 all the participants received a multifaceted intervention with clear guidelines on when UTIs must be suspected. Based on medical literature and the expertise of the project consortium members, the authors developed and endorsed by consensus a simplified algorithm to assess unnecessary antibiotic use in residents without indwelling catheters. A second registration is taking place again from February to April 2025.Results At the time this abstract is written, a second registration is underway. During the first audit registration, conducted across 109 nursing homes, nursing staff recorded 2,773 antibiotic-treated infections. Of these, 1,158 (41.8%) were treated for UTIs. Among 975 UTI cases in residents without catheters, 54.1% may have been treated unnecessarily based on the algorithm developed. A trend toward increased, potentially unnecessary antibiotic use was noted when urine dipstick tests were performed. During the conference, a comparison of the results from the first and second registrations will be presented.Conclusions Preventing overdiagnosis in nursing homes requires a strong focus on empowering nursing staff, who play a critical role in the early identification of infections. It is essential to provide them with the appropriate training, tools, and support to accurately assess whether a UTI is present. Given that nursing staff are often the first to suspect an infection, their ability to distinguish between true UTIs and non-specific symptoms is crucial for reducing unneces-sary antibiotic use. The findings from the first registration phase of the study clearly high-light this need. The impact of the intervention on reducing unnecessary overdiagnosis will be presented during this conference.