Preface

The urogenital tract (UGT)—which is a combination of urinary tract and genital tract—as well as other tracts in the human body have their own characteristics and properties. There are differences in the UGTs of men and women. In men, the UGT is normally sterile and involves no microbial normal flora. In contrast, the vaginal section of the UGT in women possesses its own microbial normal flora, including *Lactobacillus* spp., which play an impor‐ tant role in maintaining the natural balance of the microbial populations for inhibiting pathogen colonization in the vagina. Besides, the anatomical position of the anus and the UGT facilitates the occurrence of UGT infections (UGTIs) in women.

Therefore, the incidence and prevalence of UGTIs in women is much more than it is in men with a healthy immune system and no predisposing factors. In accordance with several differ‐ ent investigations we now know that urinary tract infections (UTIs) rank second among other infectious diseases and this makes UTIs a huge global concern in public healthcare systems.

In this delicate situation, it is important to classify the risk factors of UGTIs comprising gen‐ der, age, microbial agents, environmental factors, genetics, and immunodeficiency.

As mentioned, women more than men may suffer from UTIs or UGTIs. Moreover, the recur‐ rent UGTIs are commonly seen among women populations. Young adults, adults, and in particular sexually active women are predisposed to UGTIs.

The type of microbial agents, including Gram –ive bacteria, Gram +ive bacteria, and fungal agents, may cause different types of UGTIs (asymptomatic and symptomatic, complicated and uncomplicated, acute and chronic, lower part and/or upper part) depending on their genomic treasures and the strength of the human host. For example, *Escherichia coli* as the pioneer bacterial agent for UGTIs involves a wide range of strains such as pathotypes and non-pathotypes (commensal strains) with different virulence genes. Furthermore, Gram +ive bacteria such as Enterococci or fungal agents like *Candida albicans* have different types of virulence factors, which may cause a diversity of UGTIs. The virulence potential of microbi‐ al agents determines the type of UGTIs and activates different types of immune system cells, signaling pathways, and responses.

Environmental factors such as social behavior, personal hygiene, catheterization, and longterm hospitalization are considerable parameters that may lead to the occurrence of UGTIs with different symptoms and syndromes. Nosocomial UGTIs occur and develop with bio‐ film formation. The progression of microbial biofilms leads to the occurrence of malignant and fatal UGITs as a result of bacteremia and sepsis in patients with UGTIs.

Genetics has a key role in the occurrence of UGTIs in patients, including men, women, and even children. Genetic predisposing factors like diabetes, blood group, and immune system

responses affect directly the severity of UGTIs. Genetic factors may lead to recurrent UGTIs, too.

Immunodeficiency in patients may increase the rate of mortality. Patients with HIV can be the first level victims of UGTIs. Immunocompromised patients may have significant prob‐ lems in association with UGTIs, which may result in death.

In addition to the aforementioned items, there are important parameters that may control the rate of UGTIs or may lead to an increase in the rate of UGTIs. Thus, accurate, acute, and rapid detection of UGTIs is the first step for reduction of the rate of UGTIs among patients. Of course, the use of up-to-date guidelines is necessary to decrease the incorrect detection and recognition of UGTIs.

The second step is the use of effective drugs and antibiotics. In recent decades the number of drug-resistant microbial strains has increased, which has resulted in a global concern related to treatment procedures, methodologies, and management. For example, the extended-spec‐ trum beta-lactamases producing microbial pathogens are known as a big challenge for effec‐ tive, accurate, and definite treatment regarding UGTIs.

In this book the authors have represented their information in the format of separate chap‐ ters. Their knowledge regarding UGTIs or UTIs is admirable and I hope that readers will obtain new and practical information in the field of UTIs.

> **Payam Behzadi** Assistant Professor Department of Microbiology College of Basic Sciences Shahr-e-Qods Branch Islamic Azad University Tehran, Iran

**Chapter 1**

**Provisional chapter**

**Introductory Chapter: An Overview on Urinary Tract**

**Introductory Chapter: An Overview on Urinary Tract** 

Urinary tract infections (UTIs), the second-ranked infectious diseases, are recognized as a big concern relating to global healthcare systems. The problem with UTIs is two-dimensional. From the economic aspect, patients with UTIs cost millions of US dollars (USD) for different governments annually. From the other dimension, there is a huge number of patients with UTIs which must be visited by a considerable number of physicians and specialists that involve an abundance of human resources in the public healthcare systems. So, the UTIs should be diagnosed and treated definitely at the earliest to decrease the costs and traffics in public healthcare systems [1–6].

Moreover, UTIs are known as multi-microbial infectious diseases, which can be happened by bacteria (Gram-positive and/or Gram-negative strains) and fungi. Among Gram-negative bacteria, the member of *Enterobacteriaceae* and, in particular, *Escherichia coli* and *Klebsiella pneumoniae* are the most common uropathogenic bacterial agents, which may cause different types of UTIs. Furthermore, Gram-negative bacteria, including *Streptococci*, *Staphylococci*, and *Enterococci*, are involved in UTIs in humans. On the other hand, fungi and particularly *Candida albicans* (*C. albicans*) strains may act as opportunistic pathogenic fungi for causing UTIs. However, the non-*C. albicans Candida* (NACA) such as *C. glabrata* and *C. tropicalis* are reported from some countries as the predominant species of the causative agents of UTIs [1, 2, 4, 7–14].

Fortunately, the methodologies and procedures of diagnostics are in progress, and the use of molecular techniques (e.g., polymerase chain reaction (PCR)) and advanced pan-genomic

> © 2016 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, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. 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, and reproduction in any medium, provided the original work is properly cited.

DOI: 10.5772/intechopen.82230

**Infections, Pathogens, and Risk Factors**

**1. Urinary tract infections and the related concerns**

**Infections, Pathogens, and Risk Factors**

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

**2. Urinary tract infections and diagnostics**

http://dx.doi.org/10.5772/intechopen.82230

Payam Behzadi

Payam Behzadi

#### **Introductory Chapter: An Overview on Urinary Tract Infections, Pathogens, and Risk Factors Introductory Chapter: An Overview on Urinary Tract Infections, Pathogens, and Risk Factors**

DOI: 10.5772/intechopen.82230

Payam Behzadi Payam Behzadi

responses affect directly the severity of UGTIs. Genetic factors may lead to recurrent UGTIs,

Immunodeficiency in patients may increase the rate of mortality. Patients with HIV can be the first level victims of UGTIs. Immunocompromised patients may have significant prob‐

In addition to the aforementioned items, there are important parameters that may control the rate of UGTIs or may lead to an increase in the rate of UGTIs. Thus, accurate, acute, and rapid detection of UGTIs is the first step for reduction of the rate of UGTIs among patients. Of course, the use of up-to-date guidelines is necessary to decrease the incorrect detection

The second step is the use of effective drugs and antibiotics. In recent decades the number of drug-resistant microbial strains has increased, which has resulted in a global concern related to treatment procedures, methodologies, and management. For example, the extended-spec‐ trum beta-lactamases producing microbial pathogens are known as a big challenge for effec‐

In this book the authors have represented their information in the format of separate chap‐ ters. Their knowledge regarding UGTIs or UTIs is admirable and I hope that readers will

> **Payam Behzadi** Assistant Professor

> > Tehran, Iran

Department of Microbiology College of Basic Sciences Shahr-e-Qods Branch Islamic Azad University

lems in association with UGTIs, which may result in death.

tive, accurate, and definite treatment regarding UGTIs.

obtain new and practical information in the field of UTIs.

too.

VIII Preface

and recognition of UGTIs.

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.82230
