**9. Conclusion**

Urinary tract infection is one of the most common healthcare problems facing women, and almost half of women will have a UTI during their lifetime. The incidence is much lower in men, but increases with age. About 15% of women will have problems with recurrent UTI despite having no anatomic abnormalities of the urinary tract. This is likely due to genetic variations in their mucosal protective defense mechanisms that predispose them to bacterial colonization. Preventive strategies should be used liberally in this group of patients and should focus on non-pharmacologic measures first to avoid the ever-increasing drug resistance that is developing worldwide.

Simple hygienic measures are helpful, including proper wiping techniques and voiding after intercourse, and possibly avoiding tub baths. Diaphragms and contraceptive methods containing nonoxynol-9 should be avoided. Cranberry juice or tablets are likely an effective and risk free preventive measure, and should be taken three times daily. Methenamine is an old measure that has been shown to be effective for uncomplicated patients as well. After menopause, these women should use vaginal estrogen therapy which has been shown to decrease recurrences in several studies. If patients continue to have frequent infections despite these measures, a regimen of antibiotic prophylaxis should be started. This can be a single dose taken after intercourse if the patient is sexually active and intercourse triggers an infection. For women who don't have this problem but still have frequent infections, patient- initiated therapy is very effective. The patient has a supply of antibiotic on hand to take at the first sign of symptoms. Finally, for women who continue to have infections despite these strategies, a daily dose of suppression may be needed for 3 to 6 months. However, her risk of infection returns to baseline and remains high when this therapy is discontinued. The antibiotics used most often in suppressive regimens are nitrofurantoin and TMP/SMX

CAUTI remains the leading cause of hospital acquired infections worldwide. Although use of a urethral catheter is at times a necessary part of caring for patients, there are proven steps that can decrease the infection rate. Most importantly, catheters should be placed only for accepted indications and not for incontinence or convenience. For postoperative female patients undergoing uncomplicated procedures, including gynecologic procedures, we should rethink the practice of routine foley placement during the procedure. Instead, consider intermittent in/out catheterization until she is able to ambulate and void satisfactorily. For men without cognitive impairment and obstruction, a condom catheter should be used. More research is needed in the bladder management of the postoperative patient, as well as the role of cranberry to prevent CAUTI. When Foleys are placed, the need for ongoing catheterization should be assessed daily and the catheter discontinued as soon as possible. Reminder systems, whether an electronic reminder or a paper sticker for those not yet using electronic systems, have been shown to lower infection rates and should always be used when a foley is placed.
