**6. Bacteriuria**

Comparative studies are difficult to perform in these patient groups due to different definitions of bacteriuria and urinary tract infection, different urinary tract drainage methods, as well as the severity of acute, subacute, chronic, or total and partial lesions. In 1992, according to the National Institute on Disability Rehabilitation Research, severe bacteriuria is defined as the number of colony counts of 10<sup>2</sup> CFU uropathogenic micro granules per ml of urine in samples taken by catheterization, 10<sup>4</sup> CFU/ml urine samples under pure micturition and any detectable uropathogenic concentration in samples from permanent catheter or supraventricular puncture. Other researchers continue to regard the concentration of 105 CFU/ml in urine as a criterion for significant bacteriuria even in samples after catheterization [73]. Waites et al. reported that patients with 10 CFU/ml in urine have a 10% risk of a febrile episode, while the presence of pyuria is more associated with fever and shivering [73]. In patients receiving 40% IC, the source of bacteriuria was the upper urinary tract, while in 60%, the source was the lower urinary tract [74]. Pyuria was much higher in patients with upper urinary tract infection [75].

**9. Bladder catheterization**

**10. Biofilm management**

Efforts to eliminate bacteriuria due to the use of permanent or intermittent catheterization have no effect. Intensive or continuous catheterization is a frequent but not documented method of treatment to prevent sedimentation, bacteriuria, urinary tract infection and/or bacteremia. Intravenous administration with neomycin/polymyxin has no effect. Spinal hygiene, perineal wash, and frequent catheter changes have found ineffective methods in reducing urinary tract infection due to catheterization [82]. In addition, it is important for both coating and catheter composition. Prevention of *P. aeruginosa* biofilm formation is observed using silver-coated catheters [83].

Urinary Tract Infections in Neuro-Patients http://dx.doi.org/10.5772/intechopen.79690 69

As mentioned above, a general feature of the microorganisms that form the bio-membranes is their resistance to various antimicrobial substances, as opposed to free-flowing cells. The main objective should prevent biofilm formation by the prophylactic administration of antibiotics and strict adherence to antisepsis rules when attaching any prosthetic material and in this case a catheter. It is also proposed to incorporate antimicrobial agents into the material to be implanted and to modify the physical or chemical properties of the material so as not to favor biofilm formation.

To achieve satisfactory penetration of antimicrobial drugs into the bio-membrane, experimentally liposomal forms of drugs have been tested with encouraging results. Reid et al. claimed that the daily use of cranberry helmet juice drastically reduced the formation of biofilm and reduced the adhesion of Gram-negative and -positive microorganisms to bladder cells [84]. Respectively, in more recent studies and post-analysis, the clinical benefit of using cranberry juice to reduce urinary tract infections appears to be limited to recurrent urothelial infections

The use of antimicrobial drugs for the prevention of UTIs in people who have intermittent catheterization or carry an indwelling bladder catheter has some positive results. In some studies, prophylactic antibiotics are reported to be effective. The use of methenamine orally and intake of acidic substances contributes to the reduction of urinary tract infection in the case of intermittent catheterization [87]. A low dose of ciprofloxacin appears to be more effective than placebo in preventing urinary tract infection [88]. In a study, administration of the 500 mg twice daily dose for 10 days reduced the incidence of Gram-negative organisms in the perineum and urethra but ciprofloxacin-susceptible microorganisms were replaced by resistant microorganisms such as staphylococci, including methicillin-resistant *S. aureus*, Enterococci and Acinetobacter spp. [89]. In contrast to the above, comparative studies of prophylactic administration of ascorbic acid, TMP-SMX, nalidixic acid, methenamine hippurate, or nitrofurantoin microcrystals to prevent urinary tract infection in patients with SCI did not provide statistically significant results. In a daily use of TMP-SMX study compared to placebo as a prophylaxis for urinary tract infections in SCI patients, the use of TMP-SMX did not reduce the incidence of symptomatic bacteremia while there was an increase in TMP-SMX resistance in asymptomatic patients [90].

in women without neurogenic urinary disorders of young and middle age [85, 86].
