Preface

**Section 3 Genetical and Immunological Implications for Urinary Tract**

**Pyelonephritis and Post-infectious Renal Damage 137** Maja Zivkovic, Ljiljana Stojkovic, Brankica Spasojevic-Dimitrijeva,

**Recurrent Urinary Tract Infections – Where Are We? 161** Thomas Nelius, Christopher Winter, Julia Willingham and Stephanie

Chapter 7 **Genetic Factors Underlying Susceptibility to Acute**

Mirjana Kostic and Aleksandra Stankovic

Chapter 8 **Immune-Based Treatment Strategies for Patients with**

**Infections 135**

**VI** Contents

Filleur

Urinary tract infections (UTI) continue to be under the most common bacterial infections worldwide. Diagnostic and treatment have substantial financial burden on society. In the USA, UTIs are responsible for more than 7 million physician visits annually and about 15% of all community-prescribed antibiotics in the USA are dispensed for UTIs. About 50% of women will experience at least one UTI episode during lifetime, about 1 million emergency department visits due to UTI in the USA alone, resulting in more than 100 000 hospital ad‐ missions annually, most often for pyelonephritis. Moreover, UTIs are also the leading cause of hospital-acquired infections, accounting for approximately 40% of all such cases. The ma‐ jority of these cases are catheter-associated. Therefore, nosocomial UTIs comprise perhaps the largest institutional reservoir for nosocomial antibiotic-resistant pathogens. Beside the economic impact, UTIs affect also significantly the quality of life of the affected population. The aim of this book is to highlight problematic aspects and recent advances in the field of UTIs. The book is divided in three parts.

The first part covers issues regarding catheter-associated UTIs including prevention, prob‐ lems in developing countries and the role of bacterial biofilms.

In the second part deals with potential new diagnostic developments for pediatric related UTIs. This includes new concepts regarding dysfunctional voiding and new anatomical as‐ pects of the vesico-ureteral junction.

Genetic factors underlying susceptibility upper UTIs and potential immune-based treatment strategies are discussed in the third part of the book.

> **Thomas Nelius** Texas Tech University Health Sciences Center, Department of Urology, Lubbock, Texas United States of America

**Section 1**

**Management of Catheter-Associated Urinary**

**Tract Infections**

**Management of Catheter-Associated Urinary Tract Infections**

**Chapter 1**

**Prevention of Urinary Tract Infections in the Outpatient**

Urinary tract infections (UTIs) are one of the most common health problems plaguing women. About half of women will experience a UTI during their lifetime. The incidence is much lower in men but increases with age. In patients over the age of 65, at least 20% of women and 10% of men have bacteruria [1]. The incidence also increases with hospitalization or institutional‐ ization. UTIs are the most common nosocomial infection, and more than 80% of these are associated with an indwelling catheter [2]. There is also a higher risk of UTIS in pregnancy and some chronic diseases including diabetes, multiple sclerosis, spinal cord injuries or disease,

The cost of treating UTIs is substantial both in inpatient and outpatient settings. In the United States in the year 2007, approximately 2.47 billion dollars were spent on outpatient treatment of UTI and this excluded spending on prescriptions [3]. The estimated cost of nosocomial UTIS is approximately 2.66 billion dollars in 2007 dollars [4]. There are simple and effective measures for prevention of UTIs which can significantly limit morbidity and cost, but these are often

Certain patients, particularly women, despite having normal anatomy and function of the urinary tract, are genetically predisposed to urinary tract infections. This tendency seems to be related to variations in the urinary tract epithelium and it's interaction with bacteria. Once a person has a UTI, he or she is more likely to get another within a year. Recurrence rates in women vary from 28 to 82%, with higher rates seen in women with a prior history of UTI [5]. The risk of recurrent UTIs increases with higher number of prior infections. It also decreases with a longer time interval between the first and second infections. [4] However, even with long intervals between infections, about one sixth of women have difficulties with recurrent infections throughout their lifetime [4]. Preventive strategies should be targeted to this group.

> © 2013 Kammire; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

distribution, and reproduction in any medium, provided the original work is properly cited.

and reproduction in any medium, provided the original work is properly cited.

**and Inpatient Settings**

Additional information is available at the end of the chapter

and immunosuppressive diseases such as HIV.

Leslie Kammire

**1. Introduction**

overlooked,

http://dx.doi.org/10.5772/56709
