**Author details**

**8. Other preventive measures**

18 Recent Advances in the Field of Urinary Tract Infections

**9. Conclusion**

is developing worldwide.

The use of prophylaxis for CAUTI with cranberry products is mentioned in the IDSA guide‐ lines but not in the CDC, with the note that cranberry products should not be used routinely to reduce CAUTI in patients with neurogenic bladders with chronic intermittent OR indwel‐ ling catheters. They also noted insufficient date to recommend using cranberry products for other groups. However, these guidelines were published in 2009 before more recent studies that have shown some benefit to cranberry products. The previously cited study by Mutlu, although small, concluded that cranberry capsules could be an encouraging option for the prevention of recurrent UTI in children with neurogenic bladder caused by myelomeningocele who required chronic intermittent catheterization [47.] Because cranberry capsules are safe, inexpensive, well tolerated and don't cause any drug resistance, it would seem worthwhile to

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

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

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

use them in these high risk populations as a first line preventive measures.

most often in suppressive regimens are nitrofurantoin and TMP/SMX

### Leslie Kammire

Wake Forest School of Medicine, Department of Obstetrics and Gynecology, Winston-Salem, North Carolina, USA

## **References**


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tice Guidelines from the Infectious Disease Society of America. Clinical infectious Disease 2010;50 625-663

**Chapter 2**

**Prevention of**

http://dx.doi.org/10.5772/52957

**1. Introduction**

**2. Epidemiology**

TIs is estimated to be \$340-370 million [14, 15].

**Catheter-Associated Urinary Tract Infections**

Urinary catheter placement is an extremely common medical intervention. It can be used either temporarily, for example to drain a full bladder, to monitor urine output or it can be indwelling for long term drainage. While urinary catheters are a safe medical practice, complications can and do arise from their use and can be a source of morbidity for hospital or nursing home residents. The term "catheter fever" was used for the first time in 1883 [1] and it has been 50 years since Beeson, et al., recognized the potential harms arising from urethral catheterization and penned an editorial to the American Journal of Medicine titled "The case against the catheter" [2]. Nowadays, it is well recognized that catheter-associated infections (CAUTIs) cause the vast majority of nosocomial urinary tract infections (UTIs) [3, 4]. Designing an effective strategy for prevention of CAUTI presupposes an in depth knowledge of epidemi‐

Generally, UTIs comprise the 40% of hospital-acquired infections [5-9] and 80% of them are CAUTIs [10-11]. CAUTIs are directly related with the use of indwelling urinary cath‐ eters [12, 13]. Up to 25% of patients have an indwelling catheter placed at some time during their hospital stay [3]. CAUTIs are associated with increased morbidity, mortality, length of hospital stay and cost. It has been estimated that one episode of nosocomial ac‐ quired UTI adds 1–3 days of extra hospital stay [3]. Moreover, the annual cost of CAU‐

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ology, pathogenesis, microbiology and risk factors for all medical personnel.

Ioannis Efthimiou and Kostadinos Skrepetis

Additional information is available at the end of the chapter

