**Author details**

• patients belonging to high-risk groups (immunosuppressed)

72 Microbiology of Urinary Tract Infections - Microbial Agents and Predisposing Factors

**16. Conclusion**

• strains of microorganisms suspected of bacteremia such as Serratia marcescens [132–135].

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].

Urinary tract infections are a grade issue for medical doctors and patients. It is even more difficult to diagnose and treat neurogenic patients rather than general population. The higher frequency of recurrent infections in these patients and resistant microorganisms remain the main problems as for this specific population. In summary, based on the criteria of evidencebased medicine, there is currently no preventive measure for recurrent urinary tract infections in neurogenic patients that can be recommended without limitations. Individualized concepts, including immunostimulation, phytotherapy, and complementary medicine, should be taken into consideration [146]. Prophylaxis is important to pursue, but there are no data favoring one approach over another. In this case, prophylaxis is essentially a trial and error approach. Nowadays, the quality of life of the neurogenic patients is the primary concern. Antibiotics, catheterization techniques and urinary diversions are the main features of treatment applied. The medical community contributes in this direction with the proper diagnosis of the diseases Charalampos Konstantinidis1 \* and Achilleas Karafotias2

