ObjectivesTo quantify the prevalence of documented urinary tract infection (UTI), nonspecific symptoms, and antibiotic treatment of suspected UTI in nursing homes (NHs) in the tropics and to describe the typical resident likely to receive antibiotic treatment for suspected UTI and factors associated with the development of confusion, fatigue, and restlessness.DesignCross‐sectional.SettingFive far north Queensland NHs in tropical Australia.ParticipantsNH residents (N = 450).MeasurementsChart reviews of NH residents between August 28, 2015, and June 21, 2016, to determine the prevalence of documented UTI, new or worsening nonspecific and specific symptoms that are specific or nonspecific to the urinary tract, antibiotic use, medical conditions, and medication factors.ResultsUTI accounted for 33% of all current infections treated with antibiotics and 40% of all infections treated with antibiotics within the last 30 days. One in 5 NH residents had received antibiotics within the last 30 days, of which 45% were for UTI. The most significant factors independently associated with antibiotics for UTI were urinary catheter (OR = 13, 95% CI = 2.4–67, P = .003), urinary frequency (OR = 10, 95% CI = 2.2–47, P = .003), fever (OR = 10, 95% CI = 1.3–85, P = .028), new‐onset hypotension (OR = 10, 95% CI = 1.4–73, P = .024), and confusion (OR = 8.9, 95% CI = 3.1–26, P < .001). Of these, confusion was the most prevalent factor in the population.ConclusionUTI is commonly documented in NH residents, with new or worsening confusion being one of the strongest factors associated with antibiotic treatment for suspected UTI.