**15. Treatment**

Generally, asymptomatic bacteriuria does not require treatment because the microorganism cannot be eliminated or will recur after the treatment is complete. In addition, antimicrobial therapy will lead to resistant strains of microorganisms [130, 131]. Therefore, there is no indication that treatment reduces virulence or mortality. Systemic antimicrobial therapy for asymptomatic bacteriuria is recommended only in special cases such as:


in this group of patients. Personalized physician and patient collaboration and the timely recognition of symptoms by the patient remain the cutting edge of early symptoms relief. The proper and efficient control of the "neurogenic bladder" is essential for the prevention and the management of the UTIs. The controlled bladder pressure and its complete periodical evacuation under a low-pressure environment can ensure that the UTIs will be less frequent and less severe.

Urinary Tract Infections in Neuro-Patients http://dx.doi.org/10.5772/intechopen.79690 73

\* and Achilleas Karafotias2

1 Urology and Neuro-Urology Unit, National Rehabilitation Center, Athens, Greece

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2 Urology Department, General Hospital "Asklepieio Voulas", Athens, Greece

\*Address all correspondence to: konstantinidischaralampos@yahoo.com

**Author details**

**References**

Charalampos Konstantinidis1

Symptomatic UTI in the neurogenic patient is defined as a urinary culture with ≥10<sup>2</sup> CFU bacteria/mL and symptoms including, but not limited, to LUTS, urinary incontinence, increased spasticity, autonomic dysreflexia, pelvic discomfort, fever, and decreased energy level. Moreover, it has not been shown that the type of microbe isolated in urine culture of an asymptomatic patient is the cause of infection when a symptomatic episode occurs. In 30–50% of cases, urinary catheter removal is accompanied by urinary tract purification by the microorganism [40, 134]. People with symptomatic bacteriuria—UTI should be treated with the most specific antibiotic treatment for the shortest but sufficient period. Since the urinary catheter surface, due to biofilm formation becomes a source of bacterial growth, it is justified and important to remove it and replace it with a new one before treatment of symptomatic infection [40, 136–139]. The guidelines for choosing the right antimicrobial treatment are the same as those of the general population. They include the identification of the microorganism, antimicrobial susceptibility, the location of the infection, its complexity, and the risk factors.

Although there are insufficient clinical studies on the duration of treatment for urinary tract infections in neurogenic patients, the duration of treatment varies from 3 to 21 days depending on the microorganism, the accompanying factors of infection and the condition of the patient [138, 140, 141]. When oral treatment is sufficient, it is usually given for a period of 5–7 days, and when intravenous treatment is required, it remains from 7 to 14 days depending on the clinical and laboratory findings [142]. In the appearance of fungi in urethral cultures, treatment is unnecessary. In this case, either local (intravesical) or systemic antifungal treatment [143, 144] is not recommended, and it is recommended to replace the catheter with a new one. If the infection is accompanied by symptoms of the urinary tract or the presence of fungus is a symptom of systemic infection, then antifungal treatment is necessary [145].
