Dr. Pletser’s experience includes 30 years of working with the European Space Agency as a Senior Physicist/Engineer and coordinating their parabolic flight campaigns, and he is the Guinness World Record holder for the most number of aircraft flown (12) in parabolas, personally logging more than 7,300 parabolas.
\\n\\n
Seeing the 5,000th book published makes us at the same time proud, happy, humble, and grateful. This is a great opportunity to stop and celebrate what we have done so far, but is also an opportunity to engage even more, grow, and succeed. It wouldn't be possible to get here without the synergy of team members’ hard work and authors and editors who devote time and their expertise into Open Access book publishing with us.
\\n\\n
Over these years, we have gone from pioneering the scientific Open Access book publishing field to being the world’s largest Open Access book publisher. Nonetheless, our vision has remained the same: to meet the challenges of making relevant knowledge available to the worldwide community under the Open Access model.
\\n\\n
We are excited about the present, and we look forward to sharing many more successes in the future.
\\n\\n
Thank you all for being part of the journey. 5,000 times thank you!
\\n\\n
Now with 5,000 titles available Open Access, which one will you read next?
Preparation of Space Experiments edited by international leading expert Dr. Vladimir Pletser, Director of Space Training Operations at Blue Abyss is the 5,000th Open Access book published by IntechOpen and our milestone publication!
\n\n
"This book presents some of the current trends in space microgravity research. The eleven chapters introduce various facets of space research in physical sciences, human physiology and technology developed using the microgravity environment not only to improve our fundamental understanding in these domains but also to adapt this new knowledge for application on earth." says the editor. Listen what else Dr. Pletser has to say...
\n\n\n\n
Dr. Pletser’s experience includes 30 years of working with the European Space Agency as a Senior Physicist/Engineer and coordinating their parabolic flight campaigns, and he is the Guinness World Record holder for the most number of aircraft flown (12) in parabolas, personally logging more than 7,300 parabolas.
\n\n
Seeing the 5,000th book published makes us at the same time proud, happy, humble, and grateful. This is a great opportunity to stop and celebrate what we have done so far, but is also an opportunity to engage even more, grow, and succeed. It wouldn't be possible to get here without the synergy of team members’ hard work and authors and editors who devote time and their expertise into Open Access book publishing with us.
\n\n
Over these years, we have gone from pioneering the scientific Open Access book publishing field to being the world’s largest Open Access book publisher. Nonetheless, our vision has remained the same: to meet the challenges of making relevant knowledge available to the worldwide community under the Open Access model.
\n\n
We are excited about the present, and we look forward to sharing many more successes in the future.
\n\n
Thank you all for being part of the journey. 5,000 times thank you!
\n\n
Now with 5,000 titles available Open Access, which one will you read next?
\n'}],latestNews:[{slug:"stanford-university-identifies-top-2-scientists-over-1-000-are-intechopen-authors-and-editors-20210122",title:"Stanford University Identifies Top 2% Scientists, Over 1,000 are IntechOpen Authors and Editors"},{slug:"intechopen-authors-included-in-the-highly-cited-researchers-list-for-2020-20210121",title:"IntechOpen Authors Included in the Highly Cited Researchers List for 2020"},{slug:"intechopen-maintains-position-as-the-world-s-largest-oa-book-publisher-20201218",title:"IntechOpen Maintains Position as the World’s Largest OA Book Publisher"},{slug:"all-intechopen-books-available-on-perlego-20201215",title:"All IntechOpen Books Available on Perlego"},{slug:"oiv-awards-recognizes-intechopen-s-editors-20201127",title:"OIV Awards Recognizes IntechOpen's Editors"},{slug:"intechopen-joins-crossref-s-initiative-for-open-abstracts-i4oa-to-boost-the-discovery-of-research-20201005",title:"IntechOpen joins Crossref's Initiative for Open Abstracts (I4OA) to Boost the Discovery of Research"},{slug:"intechopen-hits-milestone-5-000-open-access-books-published-20200908",title:"IntechOpen hits milestone: 5,000 Open Access books published!"},{slug:"intechopen-books-hosted-on-the-mathworks-book-program-20200819",title:"IntechOpen Books Hosted on the MathWorks Book Program"}]},book:{item:{type:"book",id:"1318",leadTitle:null,fullTitle:"Urinary Tract Infections",title:"Urinary Tract Infections",subtitle:null,reviewType:"peer-reviewed",abstract:"Urinary tract infections (UTIs) are among the most common bacterial infections worldwide, and they are also the leading cause of hospital-acquired infections. Therefore, the appropriate management of UTIs is a major medical and financial issue. This book covers different clinical manifestations of UTI, with special emphasis on some hard-to-treat diseases, and special conditions in respect of treatment; antibiotic resistance and the available alternative strategies for the prevention and treatment of UTIs and it deals with urinary tract infections in children. The aim of this book is to give a summary about the different aspects of the diagnosis, management and prevention of urinary tract infections for all medical disciplines.",isbn:null,printIsbn:"978-953-307-757-4",pdfIsbn:"978-953-51-6511-8",doi:"10.5772/1788",price:139,priceEur:155,priceUsd:179,slug:"urinary-tract-infections",numberOfPages:372,isOpenForSubmission:!1,isInWos:1,hash:"018471a7330e239e2bfbd8b11b1111ca",bookSignature:"Peter Tenke",publishedDate:"October 3rd 2011",coverURL:"https://cdn.intechopen.com/books/images_new/1318.jpg",numberOfDownloads:70135,numberOfWosCitations:21,numberOfCrossrefCitations:8,numberOfDimensionsCitations:23,hasAltmetrics:0,numberOfTotalCitations:52,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"November 16th 2010",dateEndSecondStepPublish:"December 14th 2010",dateEndThirdStepPublish:"April 20th 2011",dateEndFourthStepPublish:"May 20th 2011",dateEndFifthStepPublish:"July 19th 2011",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,editors:[{id:"62770",title:"Dr.",name:"Peter",middleName:null,surname:"Tenke",slug:"peter-tenke",fullName:"Peter Tenke",profilePictureURL:"https://mts.intechopen.com/storage/users/62770/images/1981_n.jpg",biography:"Dr. Peter Tenke was born in 1960 in Budapest. He graduated at the Semmelweis Medical University, Budapest in 1985, and become a licensed urologist in 1989. The main field of his scientific interest are infections in urology and uro-oncology. He received his PhD in 2005 (Foreign bodies in uro-infections), and since then, he is the head of the Department of Urology at South-Pest Hospital. He earned his Habilitation in 2008. \nDr. Tenke is a member of the Hungarian and the European Association of Urology, and a Board Member of the European Society for Infection of Urology (ESIU) since 2005. He has delivered many lectures and seminars world-wide about urological infections, especially the role of catheters and foreign bodies. 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Despite the growing interest and despite the fact that the number of women entrepreneurs has accelerated radically in recent years (Weiler & Bernasek, 2001) the gender gap in entrepreneurship is still very big. This is clearly evident in the Global Entrepreneurship Monitor (GEM)Reports on Women and Entrepreneurship (Allen, Elam, Langowitz & Dean, 2007; Allen, Langowotz & Minniti, 2006; Minniti, Allen & Langowotz, 2005) that examined the rates of entrepreneurship in over 40 countries and showed that in all these countries the rates of women\'s entrepreneurship were lower than men\'s. The 2009 data are based on 55 countries, but the picture remained very similar, as can be seen in the data presented in GEM Figure 1 which show early stage entrepreneurial activity rates by gender (Bosma&Levie, 2009 p. 25).
\n\t\t\t
Even a cursory examination of GEM Figure 1 reveals several interesting findings, such as the very different rates of entrepreneurship in the different countries, ranging from as low as five percent to as high as over 35%. Part of the explanation for these differences, suggested by GEM, are the different types of economies, ranging from the poorest factor driven economies, through efficiency driven economies, all the way to the most advanced innovation driven economies.
\n\t\t\t
Another interesting finding is the different percent of women as compared to men entrepreneurs in the different countries, ranging from a relatively small difference in countries such as Ecuador, Brazil and Tonga to a relatively large difference in countries such as Korea, Norway and France. In only two countries, Guatemala and Brazil, the percent of women entrepreneurs was higher than that of men. In all other 53 GEM countries, the percent of men entrepreneurs was higher than that of women.
\n\t\t\t
The surprisingfinding that the percent of women entrepreneurs is higher in countries where the general income per capita is small and where women have no other option for
\n\t\t\t
Figure 1.
Early-Stage Entrepreneurial Activity Rates by Gender, 2009.
\n\t\t\t
making a living (such as Ecuador) and lower in countries where the general income per capita is high (such as Norway) has been explained as a result of the difference between "necessity" and "opportunity" entrepreneurship, with necessity entrepreneurship found to be more prevalent among women (Allen, et al., 2006; Allen, et al., 2007; Bosma et al., 2009; Reynolds, Bygrave, Autio, Cox, & Hay, 2003). Related terms used in the entrepreneurial literature are "push" vs. "pull" factors, where "push" factors force people to become entrepreneurs, while "pull" factors attract them to entrepreneurship (Orhan & Scott, 2001). Women in poor countries, it seems, are more influenced by "push" than by "pull" factors. In other words, when women are forced to by economic conditions they can be much more entrepreneurial; which is to say, women’s entrepreneurship is as much a result of circumstances as it is a result of innate tendencies.
\n\t\t\t
This conclusion times the question of gender differences in entrepreneurship to the larger question of the origins of gender differences in human behavior. As noted by Eagly and Wood (1999), the origins of sex differences in human behavior may lie mainly in evolved dispositions that differ by sex or mainly in the differing placement of women and men in the social structure. Thedifference between these two options is critical because if gender differences are the result of social forces such as socialization, cultural norms and gender roles and stereotypes, they can be assumed to be changeable (e.g., Deaux &LaFrance, 1998; Ruble & Martin, 1998; Spence & Buckner, 2000). But if they result from evolutionary forces (e.g., Buss, 2000; Fisher, 1999) then they are innate and fundamentally unchangeable.
\n\t\t\t
The discovery of cross-cultural variation in gender differences in entrepreneurship can be viewed as supporting the social structural (rather than evolutionary or biological) explanation for gender differences in entrepreneurship. Another finding that can support the social perspective, is similarity in entrepreneurship between men and women. Such similarity can be explained by Schneider\'s (1987) Attraction Selection Attrition (ASA) model. Schneider’s basic proposition as that the processes of attraction to organizations, selection into organizations, and attrition from organizations produce over time a restriction of range on individual differences. Consequently, people who remain in an organization over time come to be rather similar. This has been referred to as the homogeneity hypothesis (e.g., Denton, 1999; Schneider, Smith, Taylor, & Fleenor, 1998). Based on Schneider\'s model, it can be expected that men and women who are attracted to an entrepreneurial career, who go through the selection process that screens out those who don\'t have the needed attitudes and personality, and who acquire the skills and experience needed for running a business, end up being rather similar, whether they are male or female.
\n\t\t\t
This proposition was examined by Pines and Schwartz (2008) in three studies that addressed gender differences in entrepreneurship. Each study focused on a different subject population and different entrepreneurial activity. The first was a national telephone survey of adults. Its results showed few gender differences in entrepreneurial values. However, women described themselves as valuing job security more than men and men described themselves as more confident and as loving challenges more than women.
\n\t\t\t
The second study involved management students who responded to a self-report questionnaire. Its results showed large gender differences in the willingness to start a business. About twice as many male than female students either had a business or intended to start one. Male students viewed themselves as more suitable to be a business owner, expressed greater preference for being one, and described themselves as being more entrepreneurial.
\n\t\t\t
These findings can be explained by women’s tendency to perceive themselves in a less favorable light as entrepreneurs than men (Langowitz & Minniti\'s, 2007). However, all these gender differences almost disappeared in the group of the management students who either owned a business or intended to start a business.
\n\t\t\t
The third study involved interviews with small business owners. Its results showed far more similarities than differences between male and female business owners, including similarities in demographic characteristics, work and businesses characteristics and reasons for starting a business.
\n\t\t\t
Combined, the three studies can be interpreted as supporting Schneider\'s (1987) ASA model and the social perspective on the origin of gender differences in the case of men and women entrepreneurs. The current chapter extends the discussion of the gender gapinentrepreneurship to a comparison between business and social entrepreneurs.
\n\t\t\tSocial entrepreneurship has been growing fast in recent decades with the growing number of third-sector organizations, the segment of the economy that is neither public nor business. The trend in many countries of adopting the ideology of diminishing government involvement in the economy and in society has made it increasingly more difficult for welfare states to answer social needs and claims, and has broadened their reliance on the activities of the third-sector nonprofit organizations (NPOs) (Sharir & Lerner, 2006). As a result there is growing interest in the activities of social entrepreneurs in different countries and contexts.Social entrepreneurs have been described as “People who realize where there is an opportunity to satisfy some unmet need that the state welfare system will not or cannot meet and who gather the necessary resources and use these to ‘make a difference ’” (Thompson, Alvy & Lees 2000). As such, social entrepreneurs are perceived as change agents who create and sustain social value without being limited by the resources at hand (Stevenson &Jarrilo, 1991).
Like business entrepreneurs, social entrepreneurs establish new organizations, develop and implement innovative programs, and organize or distribute new services. Even though they are differently motivated, the challenges and problems facing social entrepreneurs during the initiation, establishment and institutionalization of their ventures resemble those faced by business entrepreneurs (Yitzhaki, Lerner & Sharir, 2008). However, their activity is valued by their ability to maximize social rather than economic returns (Sullivan Mort, Weerawardena & Carnegie, 2003).
\n\t\t\t
It appears that the main difference between entrepreneurs operating in the business sector and those operating in the not-for profit sector is in the latter\'s sense of mission and service as opposed to the goal of profitability and financial gains that characterizes the former. A sense of mission and a commitment to service, as opposed to profit,also characterize women (e.g., Fisher, 1999; Helgesen, 1990; Henning &Jardim, 1978).Thus the gender gap in entrepreneurship can be expected to be smaller in social entrepreneurship as compared to business entrepreneurship. In other words, the rate of women in social entrepreneurship can be expected to be similar or even higher of themen.
\n\t\t
\n\t\t
\n\t\t\t
2. Results
\n\t\t\t
The results of a GEM 2009 study of gender differences in Social Entrepreneurial Activity (SEA) (Bosma&Levie, 2009) offer partial support for this proposition. These findings revealed that social enterprises were more likely to be started by men than by women, but the gender gap was not as big as the Total Entrepreneurial Activity (TEA) in business enterprises. These results are evident in Figure 2 below. Figure 2 presents men’s and women’s mean SEA and TEA entrepreneurial activity by type of economy based on GEM 2009 data.
\n\t\t\t
Figure 2.
Men’s and women’s mean entrepreneurial activity by type of entrepreneurship and type of economy.
\n\t\t\t
It is clear from Figure 2 that the rate of Social Entrepreneurial Activity (SEA) of women was very similar across the three different categories of economic development, while the rates of men\'s SEA increased with economic development (lowest in Factor driven economies and highest in Innovation driven economies).
\n\t\t\t
A further examination of the gender gap in entrepreneurial activity is suggested in Table 1, which compares men and women’s early stage SEA and TEA in the three types of economies, based on GEM 2009 data.
\n\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t
SEA
\n\t\t\t\t\t\t
TEA
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t\t
Factor Driven Economies
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t
1
\n\t\t\t\t\t\t
2
\n\t\t\t\t\t\t
3
\n\t\t\t\t\t\t
4
\n\t\t\t\t\t\t
5
\n\t\t\t\t\t\t
6
\n\t\t\t\t\t\t
7
\n\t\t\t\t\t\t
8
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t\t
Female
\n\t\t\t\t\t\t
Male
\n\t\t\t\t\t\t
Difference= Male-Female
\n\t\t\t\t\t\t
Relative Difference= Difference/ Male
\n\t\t\t\t\t\t
Female
\n\t\t\t\t\t\t
Male
\n\t\t\t\t\t\t
Difference= Male-Female
\n\t\t\t\t\t\t
Relative Difference= Difference/ Male
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t\t
Average
\n\t\t\t\t\t\t
0.6
\n\t\t\t\t\t\t
0.8
\n\t\t\t\t\t\t
0.2
\n\t\t\t\t\t\t
0.3
\n\t\t\t\t\t\t
14.4
\n\t\t\t\t\t\t
20.9
\n\t\t\t\t\t\t
6.6
\n\t\t\t\t\t\t
0.4
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t\t
Std.
\n\t\t\t\t\t\t
0.6
\n\t\t\t\t\t\t
0.7
\n\t\t\t\t\t\t
0.2
\n\t\t\t\t\t\t
0.5
\n\t\t\t\t\t\t
9.2
\n\t\t\t\t\t\t
8.4
\n\t\t\t\t\t\t
4.1
\n\t\t\t\t\t\t
0.3
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t\t
Efficiency Driven Economies
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t\t
Average
\n\t\t\t\t\t\t
0.7
\n\t\t\t\t\t\t
1.1
\n\t\t\t\t\t\t
0.4
\n\t\t\t\t\t\t
0.3
\n\t\t\t\t\t\t
8.9
\n\t\t\t\t\t\t
13.5
\n\t\t\t\t\t\t
4.6
\n\t\t\t\t\t\t
0.4
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t\t
Std.
\n\t\t\t\t\t\t
0.6
\n\t\t\t\t\t\t
0.6
\n\t\t\t\t\t\t
0.4
\n\t\t\t\t\t\t
0.4
\n\t\t\t\t\t\t
5.7
\n\t\t\t\t\t\t
6.2
\n\t\t\t\t\t\t
3.5
\n\t\t\t\t\t\t
0.3
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t\t
Innovation Driven Economies
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t\t
Average
\n\t\t\t\t\t\t
0.7
\n\t\t\t\t\t\t
1.2
\n\t\t\t\t\t\t
0.5
\n\t\t\t\t\t\t
0.4
\n\t\t\t\t\t\t
4.2
\n\t\t\t\t\t\t
8.1
\n\t\t\t\t\t\t
4.0
\n\t\t\t\t\t\t
0.5
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t\t
Std.
\n\t\t\t\t\t\t
0.6
\n\t\t\t\t\t\t
0.9
\n\t\t\t\t\t\t
0.8
\n\t\t\t\t\t\t
0.3
\n\t\t\t\t\t\t
1.9
\n\t\t\t\t\t\t
3.5
\n\t\t\t\t\t\t
2.6
\n\t\t\t\t\t\t
0.3
\n\t\t\t\t\t
\n\t\t\t\t
Table 1.
Comparison between Social Entrepreneurial Activity (SEA) and Total Entrepreneurial Activity (SEA), by Type of economy and by Gender (Percentages).
\n\t\t\t
\n\t\t\t\tTable 1 presents the percent of women’s SEA (column 1) and TEA (column 5), the percent of men’s SEA (column 2) and TEA (column 6) the difference between women’s and men’s SEA (column 3) and between women’s and men’s TEA (column 7), and the relative difference in men’s entrepreneurial activity (the percent difference divided by the percent of employed men) for SEA (column 4) and TEA (column 8).
\n\t\t\t
\n\t\t\t\tTable 1 and Figure 2 show very clearly the differences between SEA and TEA, between men and women and among the three types of economy. They demonstrate the following:
\n\t\t\t
Business related entrepreneurship is much more prevalent than social entrepreneurship
Men are more entrepreneurial than women
There are different entrepreneurial rates in Factor, Efficiency and Innovation driven economies
The gender differences in entrepreneurial activity are smaller in SEA than in TEA.
Women’s SEA in the three types of economy is much more similar than women\'s TEA.
\n\t\t\t
\n\t\t\t\tTable 2 and Figure 3 present the relative difference (i.e., Male-Female/Male) between men’s and women’s Early-Stage SEA and TEA, in Factor, Efficiency and Innovation Driven economies.
\n\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t
SEA
\n\t\t\t\t\t\t
TEA
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t\t
1
\n\t\t\t\t\t\t
2
\n\t\t\t\t\t\t
3
\n\t\t\t\t\t\t
4
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t\t
Average
\n\t\t\t\t\t\t
SD
\n\t\t\t\t\t\t
Average
\n\t\t\t\t\t\t
SD
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t\t
Factor Driven Economies
\n\t\t\t\t\t\t
0.3
\n\t\t\t\t\t\t
0.5
\n\t\t\t\t\t\t
0.4
\n\t\t\t\t\t\t
0.3
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t\t
Efficiency Driven Economies
\n\t\t\t\t\t\t
0.3
\n\t\t\t\t\t\t
0.4
\n\t\t\t\t\t\t
0.4
\n\t\t\t\t\t\t
0.3
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t\t
Innovation Driven Economies
\n\t\t\t\t\t\t
0.4
\n\t\t\t\t\t\t
0.3
\n\t\t\t\t\t\t
0.5
\n\t\t\t\t\t\t
0.3
\n\t\t\t\t\t
\n\t\t\t\t
Table 2.
Comparison of the Relative Gender Difference*in SEA and TEAby Type of Economy: Averages and Standard Deviations.
*Relative Difference= (Male-Female)/Male
\n\t\t\t
Only the relative rates (means and SDs) in the entrepreneurial activity of the three types of economies are presented in Table 2: in column 1 the mean for SEA and in column 3 for TEA, in column 2 the SD for SEA and in column 4 for TEA.
\n\t\t\t
Figure 3.
Comparison of the Relative Gender Difference*in SEA and TEAby Type of Economy.
\n\t\t\t
Once again Table 2 and figure 3 make the relative differences between SEA and TEA, between men and women and among the three types of economy abundantly clear:
\n\t\t\t
When the comparison made in relative, rather than in absolute terms, the gender differences in SEA and in TEA become smaller.
Nevertheless, there are still relative differences between SEA and TEA, with smaller gender differences found in SEA in all three types of economy.
The relative gender difference is somewhat smaller in the less developed Factor and Efficiency driven economies and higher in more developed Innovation driven economies, but still, the relative difference is smaller in SEA than in TEA.
Looking at the Standard Deviations of the relative gender differences, it seems that the variability among the countries in each of the types of economy is higher in SEA than in TEA. This variability may be a reflection of the fact that this type of entrepreneurial activity is often the result of specific social and economic conditions. The higher the level of the economy, the more SEA becomes established, and probably becomes an integral part of the economic life, which causes the cross-cultural variability to diminish. Thus, the greatest variability in SEA is found in the Factor driven economies, and the lowest, in Innovation driven economies.
However, the variability of relative gender differences in TEA is very similar in the three types of economy, with no relationship to their economic level. It seems that TEA, which represents all different types of business activities, is part of the general economic fabric of countries.
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3. Discussion
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3.1. Difference between Total Entrepreneurial Activity (TEA) and Social Entrepreneurial Activity (SEA)
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The overall lower level of SEA, when compared to TEA, may be related to several reasons, paramount among them is the fact that social ventures tend to have lower levels of turnover than business related ventures, where as turnover is part and parcel of a competitive market.
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One possible explanation for thefinding that SEA is highest in more developed (Innovation Driven) economies and lowest in the least developed (Factor driven) economies, is that individuals in wealthier countries, having satisfied their own basic needs, may be more likely to turn to the needs of others. In other words, the opportunity cost of social entrepreneurship may be higher in developing countries(Bosma & Levie, 2009). This is unfortunate, because social and environmental problems are often more prevalent in developing countries.
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Examined through the lenses of opportunity vs. necessity entrepreneurship, it seems that necessity social entrepreneurship is comprised of people who were expelled from the job market and are looking for ways to get back to it. Raising awareness to social issues around them, they are able to raise financial as well as other resources. Opportunity social entrepreneurship, on the other hand, originates in worldwide trends including the shrinking role of governments in the provision of social services, the privatization of public services, and the rise in standard of living which increases awareness of the need for further services. In opportunity entrepreneurship there is a fundamental difference between less developed countries where the focus is on survival and more developed countries where ventures may be related to the standard and quality of life, such as environmental and conservation issues.
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Another explanation for thefinding that SEA is higher in more developed economies and lower in the less developed economies(suggested by Bosma & Levie, 2009)is that the definitions of a traditional business enterprise and a social enterprise may overlap in developing countries, whereas they may be more distinct in developed countries. William Baumol has suggested that the level of entrepreneurship is the same across countries, but that entrepreneurship is manifested in different ways depending on the institutional context (Baumol, 1990, 1993). In wealthier countries, social entrepreneurship may replace business entrepreneurship, at least to some extent. SEA rates are much lower than TEA rates in almost all countries. SEA as a proportion of SEA plus TEA, but not SEA itself, tends to increase with GDP per capita, providing partial support for Baumol’s hypothesis of substitution of one form of entrepreneurship for another.
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In some countries, the level of overlap of social and business entrepreneurship is quite significant, such as Peru (2.5%), Colombia (2.8%), Venezuela (1.7%) and Jamaica (2.0%).This finding is important, as it indicates that “social” and “business” entrepreneurship categories may be blurred. Earlier reported TEA levels in these countries may have included a small but still considerable level of social entrepreneurs who were running “social businesses” (Allen et al., 2007, p. 11).
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3.2. Gender difference in Total Entrepreneurial Activity (TEA) and Social Entrepreneurial Activity (SEA)
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Examination of entrepreneurial behavior around the globe yields a clear picture of a gender gap. Overall, men are more likely to be involved in entrepreneurial activity than women. This gender gap is evident in both early stage entrepreneurial participation and established business ownership, and it exists irrespective of the economic level of the country, from the lowest Factor driven economies to the highest Innovation driven economies.
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The gender gap is more pronounced in high-income economies than in either low on middle-income economies. As noted in the introduction, these differences can be explained as reflecting the difference between "necessity" and "opportunity" entrepreneurship, (Allen et al., 2006; Allen, et al., 2007; Bosma & Levie., 2009; Reynolds et al., 2003;) or "push" vs. "pull" factors (Orhan & Scott, 2001).
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While men are more likely to be involved in entrepreneurial activity than women overall, there are several interesting exceptions. In Japan, Brazil, Peru, and Thailand, for example, the entrepreneurial activities of women equal or exceed those of men (Allen et al., 2007, p.13). The gender differences arealso small inLatin Americaand Caribbean countries. These findings may be explained in part by the differences in choices for women across these country groups in which labor markets, institutional structures, and cultural norms provide a varying array of incentives to women’s entrepreneurial activity.
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When examining the gender gap in social entrepreneurship, it seems that while the gender gap still exists (there are more men than women social entrepreneurs), the difference is smaller. Furthermore, there is no difference in the rate of women social entrepreneurs in the different types of economies. The consistent gender difference can be related to the findings reported by Pines and Schwartz (2008) of women’s greater reluctance to start a business, self-perception as being less suitable to be a business owner and less entrepreneurial than men; to Langowitz and Minniti\'s, 2007 finding of women’s tendency to perceive themselves as less entrepreneurial, and to GEM data showing that men are more likely than women to say that they have the knowledge, skill and experience required to start a new business, while women are more likely to say that fear of failure would prevent them from starting a venture (Allen et Al., 2007).
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The fact that a gender gap, albeit smaller than the gender gap in TEA, still exists in SEA is significant and worrisome, because as noted earlier, social entrepreneurship seems to be an area to which women are expected to be attracted and in which they are expected to have a relative advantage.
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In our global village, public companies that are traded in the stock market in developed countries (especially in those that are characterized as Innovation driven, but gradually also in those defined as Efficiency driven) have to publicize in their balance sheets their contribution to the community. This fact, combined with the fact that a contribution to the community has become a trade mark assent, increases the prevalence of social ventures and encourages business leaders and public service leaders to initiate various social ventures. This type of social entrepreneurship is lead by high ranking public and private officials, who tend to be male, especially in the economic areas that tend to have money for ventures.
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Women in high ranking positions, however, tend to have greater difficulty taking on additional roles, since many of them still carry the main responsibility for household and child care. In addition, the economic crisis in recent years has challenges social ventures, that have to deal with budget cuts and function like traditional businesses that have to operate withinstrict budgetary limitations and at times even create revenues. The result of this trend is that the skills needed for managing social ventures are similar to those needed for managing regular ventures, and as noted earlier there is a big gender gapin those skills.
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This is critical because as social entrepreneurship is growing (especially in Innovation driven economies), there is a growing danger that women entrepreneurs will again find themselves lagging behind, and given the lower turnover rates in SEA, the danger is that this lag will remain.
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4. Implications
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The findings related to the gender gap have theoretical implications for gender theory and research and for entrepreneurship theory and research. They also have important practical implications. A study by Wilson, Kickul and Marlin (2007) demonstrated a relationship between self-efficacy and career intentions and showed that the effects of entrepreneurship education in MBA programs on entrepreneurial self-efficacy was stronger for women than for men. The implications for the importance of entrepreneurial education and training for women are obvious.
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Other implications involve the development of social networks for women entrepreneurs that will support and empower them through all the stages of establishing their venture – be it a business or a social venture.
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The findings related to the difference between SEA and TEA have important implications for business owners and managers and for policy makers as contribution to the community and social responsibility is fast becoming an important strategic asset of companies and part of the creation of value for business owners.
\n\t\t
\n\t\n',keywords:null,chapterPDFUrl:"https://cdn.intechopen.com/pdfs/31886.pdf",chapterXML:"https://mts.intechopen.com/source/xml/31886.xml",downloadPdfUrl:"/chapter/pdf-download/31886",previewPdfUrl:"/chapter/pdf-preview/31886",totalDownloads:2862,totalViews:474,totalCrossrefCites:1,totalDimensionsCites:7,hasAltmetrics:0,dateSubmitted:"June 14th 2011",dateReviewed:"September 28th 2011",datePrePublished:null,datePublished:"March 14th 2012",dateFinished:null,readingETA:"0",abstract:null,reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/31886",risUrl:"/chapter/ris/31886",book:{slug:"entrepreneurship-gender-geographies-and-social-context"},signatures:"Ayala M. Pines, Miri Lerner and Dafna Schwartz",authors:[{id:"115883",title:"Prof.",name:"Ayala",middleName:null,surname:"Malach-Pines",fullName:"Ayala Malach-Pines",slug:"ayala-malach-pines",email:"pinesa@som.bgu.ac.il",position:null,institution:{name:"Ben-Gurion University of the Negev",institutionURL:null,country:{name:"Israel"}}},{id:"115945",title:"Prof.",name:"Miri",middleName:null,surname:"Lerner",fullName:"Miri Lerner",slug:"miri-lerner",email:"lernerm@post.tau.ac.il",position:null,institution:null},{id:"115946",title:"Prof.",name:"Dafna",middleName:null,surname:"Schwartz",fullName:"Dafna Schwartz",slug:"dafna-schwartz",email:"DafnaSch@som.bgu.ac.il",position:null,institution:{name:"Ben-Gurion University of the Negev",institutionURL:null,country:{name:"Israel"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Results",level:"1"},{id:"sec_3",title:"3. Discussion",level:"1"},{id:"sec_3_2",title:"3.1. Difference between Total Entrepreneurial Activity (TEA) and Social Entrepreneurial Activity (SEA)",level:"2"},{id:"sec_4_2",title:"3.2. Gender difference in Total Entrepreneurial Activity (TEA) and Social Entrepreneurial Activity (SEA)",level:"2"},{id:"sec_6",title:"4. Implications",level:"1"}],chapterReferences:[{id:"B1",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tAllen\n\t\t\t\t\t\t\tI. E.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tElam\n\t\t\t\t\t\t\tN.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tLangowotz\n\t\t\t\t\t\t\tN.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tDean\n\t\t\t\t\t\t\tM.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t2007\n\t\t\t\t\tGlobal Entrepreneurship Monitor Report on Women and Entrepreneurship.Babson College and London Business School.\n\t\t\t'},{id:"B2",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tAllen\n\t\t\t\t\t\t\tI. 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'}],corrections:null},book:{id:"1851",title:"Entrepreneurship",subtitle:"Gender, Geographies and Social Context",fullTitle:"Entrepreneurship - Gender, Geographies and Social Context",slug:"entrepreneurship-gender-geographies-and-social-context",publishedDate:"March 14th 2012",bookSignature:"Thierry Burger-Helmchen",coverURL:"https://cdn.intechopen.com/books/images_new/1851.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"105866",title:"Prof.",name:"Thierry",middleName:null,surname:"Burger-Helmchen",slug:"thierry-burger-helmchen",fullName:"Thierry Burger-Helmchen"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},chapters:[{id:"31886",title:"Gender Differences Among Social vs. Business Entrepreneurs",slug:"gender-differences-among-social-vs-business-entrepreneurs",totalDownloads:2862,totalCrossrefCites:1,signatures:"Ayala M. 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1. General information about CAUTI
UTI affects approximately 150 million people worldwide, which is most common infection with female predominance [1]. Around 15–25% hospitalized patients receiving indwelling urinary catheter develops CAUTI with prolonged catheterization and in among 40% nosocomial UTI, 80% is due to CAUTI [2]. CAUTI causes about 20% of episodes of health-care acquired bacteraemia in intensive care facilities and over 50% in long term care facilities [3]. The microbiology of biofilm on an indwelling catheter is dynamic with continuing turnover of organisms in the biofilm. Patients continue to acquire new organisms at a rate of about 3–7%/day. In long term catheterization that is by the end of 30 days CAUTI develops in 100% patients usually with 2 or more symptoms or clinical sign of haematuria, fever, suprapubic or loin pain, visible biofilm in character or catheter tube and acute confusion all state [4]. In CAUTI the incidence of infection is Escherichia coli in 24%, Candida in 24%, Enterococcus in 14% Pseudomonas in 10%, Klebsiella in 10% and remaining part with other organisms [5]. Bacteraemia occurs in 2–4% of CAUTI patients where case fatality is three times higher than nonbacteremic patients [6]. Adhesions in bacteria initiate attachment by recognizing host cell receptors on surfaces of host cell or catheter. Adhesins initiate adherence by overcoming the electrostatic repulsion observed between bacterial cell membranes and surfaces to allow intimate interactions to occur [7]. A biofilm is an aggregate of micro-organisms in which cells adhere to each other on a surface embedded within a self-produced matrix of extracellular polymeric substance [8]. In biofilm micro-organisms growing in colonies within an extra-cellular mucopolysaccharide substance which they produce. Tamm-Horsfall protein and magnesium and calcium ions are incorporated into this material. Immediately after catheter insertion, biofilm starts to form and organisms adhere to a conditioning film of host proteins along the catheter surface. Both the inner and outer surfaces of catheter are involved. In CAUTI biofilms are initially formed by one organism but in prolonged Catheterization multiple bacteria’s are present. In biofilm main mass is formed by extra cellular polymeric substance (EPS) within which organisms live. So there are three layers in biofilm, where deeper layer is abiotic, than environmental zone and on surface biotic zone [9]. Growth of bacteria in biofilms on the inner surface of catheters promotes encrustation and may protect bacteria from antimicrobial agents and the consequence is more drug resistance of biofilm organisms. When antibiotic treatment ends the biofilm can again shed bacteria, resulting recurrent acute infection. The patients may present as asymptomatic bacteriuria or symptomatic. In symptomatic bacteriuria patient present with fever, suprapubic or costovertebral angle tenderness, and systemic symptoms such as altered mentation, hypotension, or evidence of a systemic inflammatory response syndrome. In asymptomatic CAUTI diagnosis is made with presence of 105 cfu/mL of one bacterial species in a single catheter urine specimen [10]. In symptomatic CAUTI bacteriological criteria is present with clinical symptoms.
2. The collection of specimens
It is recommended that urine specimens be obtained through the catheter port using aseptic technique or, if a port is not present, puncturing the catheter tubing with a needle and syringe in patients with short term catheterization [11]. In long term indwelling catheterization, the ideal method of obtaining urine for culture is to replace the catheter and collect the specimen from the freshly placed catheter. In a symptomatic patient, this should be done immediately prior to initiating antimicrobial therapy. Culture specimens from the urine beg should not be obtained [10, 12]. Urine sample can be collected from suprapubic puncture also. Biofilm can be cultured from the catheter, for this swab is taken from inner side of catheter.
3. Microbiologic diagnosis of CAUTI
Catheter Associated Asymptomatic Bacteriuria (CA-ASB) is diagnosed when one or more organisms are present at quantitative counts ≥105 cfu/mL from an appropriately collected urine specimen in a patient with no symptoms [13]. Lower quantitative counts may be isolated from urine specimens prior to ≥105 cfu/mL being present, but these lower counts likely reflect the presence of organisms in biofilm forming along the catheter, rather than bladder bacteriuria [14]. Thus, it is recommended that the catheter be removed and a new catheter inserted, with specimen collection from the freshly placed catheter, before antimicrobial therapy is initiated for symptomatic infection [13]. In biofilm culture, most biofilm contains mixed bacterial communities meaning polymicrobial colonization.
Patients who remain catheterized without having antimicrobial therapy and who have colony counts ≥10 2 cfu/mL (or even lower colony counts), the level of bacteriuria or candiduria uniformly increases to >105 cfu/mL within 24–48 h [14]. Given that colony counts in bladder urine as low as 102 cfu/mL are associated with symptomatic UTI in non-catheterized patients [15], untreated catheterized patients and those who have colony counts ≥102 cfu/mL or even lower, the level of bacteriuria or candiduria uniformly increases to >105 cfu/mL within 24–48 h [10, 16]. Colony counts as low as 102 cfu/mL in bladder urine may be associated with symptomatic UTI in non-catheterized patients. Whereas low colony counts in catheter urine specimens are likely to be contaminated by periurethral flora, and the colony counts will increase rapidly if untreated. Low colony counts in catheter urine specimens are also reflective of significant bacteriuria in patients with intermittent catheterization [14].
4. Other laboratory tests
Pyuria is usually present in CA-UTI, as well as in CA-ASB. The sensitivity of pyuria for detecting infections due to enterococci or yeasts appears to be lower than that for gram-negative bacilli. Dipstick testing for nitrites and leukocyte esterase was also shown to be unhelpful in establishing a diagnosis in catheterized patients hospitalized in the ICU [17].
5. Microorganisms causing CAUTI
5.1. CAUTI with E. coli
5.1.1. Introduction
It is the most common cause of CAUTI in 24–60% patients [5, 18]. In CAUTI the source of this organism is usually patients own colonic flora. E. coli is large and diverse group of bacteria found in environment, foods and intestine of human and animal. Among many species of E. coli only a few causes disease in human being. It is beneficial in that it prevents the growth and proliferation of other harmful species of bacteria. Even it plays an important role in current biological engineering.
5.1.2. Structure and pathogenesis
E. coli was discovered in 1885 by Theodor Escherich, German bacteriologist, is gram negative rod, lactose fermenter, composed of one circular chromosome which is common facultative anaerobes in colon and farces of human. Distribution is diverse and most of them are harmless belonging to genus Escherichia. Harmful species causes infection of urinary tract, gastrointestinal tract, respiratory system and rarely bacteraemia and septicemia. Phylogenetic analysis of E. coli showed majority of the strains responsible for UTI belongs to the phylogenetic group B2 and D, while in smaller percentage belong to A and B1 [19].
It has three antigens O-cell was antigen, H- flagella antigen and k- Capsular antigen. It has pili—a capsule, fimbriae, endotoxins and exotoxins also. Uropathogenic E. coli use P fimbriae (pyelonephritis-associated pili) to bind urinary tract endothelial cells. Vast majority of catheter-colonizing cells (up to 88%) express type 1 fimbriae and around 73% in E. coli causing CAUTI [20]. In UPEC fimbrial genes are ygiL, yadN, yfcV, and c2395 [21]. Pathogenesis of CAUTI initiated with UPEC colonization in periurethral and vaginal areas. Then it ascends to bladder lumen and grows as planktonic cells in urine. Sequentially adherence to bladder epithelium, then biofilm formation and invasion with replication and kidney colonization and finally bacteremia [22] (Figure 1).
Figure 1.
Gram stain picture and morphology of E. coli. Adapted from CCBC faculty web. BIOL 230 Lab Manual: gram stain of E. coli and infection landscapes: Escherichia coli. http://faculty.ccbcmd.edu/courses/bio141/labmanua/lab16/gramstain/gnrod.html.
5.1.3. Laboratory diagnosis
Diagnosis of E. coli infection is simple, by isolation and laboratory identification of bacterium from urine or biofilm. Laboratory diagnosis by culture of specimen—urine or catheter biofilm in blood agar, MacConkey’s agar or eosin-methylene blue agar (which reveal lactose fermentation). Immunomagnetic separation and specific ELISA, latex agglutination tests, colony immunoblot assays, and other immunological-based detection methods are other ways for diagnosis of E. coli.
5.2. Proteus in CAUTI
5.2.1. Introduction
Proteus species, member of the Enterobacteriaceae family of gram-negative bacilli are distinguishable from most other genera by their ability to swarm across an agar surface [23, 24]. Proteus species are most widely distributed in environment and as other enterobacteriaceae, this bacteria is part of intestinal flora of human being [25, 26]. Proteus also found in multiple environmental habitats, including long-term care facilities and hospitals. In hospital setting, it is not unusual for proteus species to colonize both the skin and mucosa of hospitalized patient and causing opportunistic nosocomial infections. It is one of the common causes of UTI in hospitalized patients undergoing urinary catheterization [26, 27].
UTIs are the most common manifestation of Proteus infection. Proteus infection accounts for 1–2% of UTIs in healthy women and 5% of hospital acquired UTIs. Catheters associated UTI have a prevalence of 20–45%. Proteus mirabilis causes 90% of proteus infection and proteus vulgaris and proteus penneri also isolated from long-term care facilities and hospital and from patients with underlying disease or specialized care. Most common age group is 20–50 years. More common in female group and the ratio between male female begins to decline after 50 years. UTI in men younger than 50 are usually caused by urologic abnormalities. Patients with recurrent infections, those with structural abnormalities of the urinary tract, those who have had urethral instrumentation or catheterization have an increase frequency of infection caused by proteus species [28].
5.2.2. Structure and pathogenesis
Proteus mirabilis produces an acidic capsular polysaccharide which was shown from glycose analysis, carboxyl reduction, methylation, periodate oxidation and the application high resolution nuclear magnetic resonance techniques. Proteus species possess an extracytoplasmic outer membrane, a common feature shared with other gram-negative bacteria. Infection depends upon the interacting organism and the host defense mechanism. Various component of the membrane interplay with the host to determine virulence. Virulence factors associated with adhesion, motility, biofilm formation, immunoavoidance, nutrient acquisition and as well as factors that cause damage to the host [29, 30] (Figure 2).
Figure 2.
Gram stain picture and morphology of Proteus. Adapted from CCBC faculty web. BIOL 230 Lab Manual: gram stain of Proteus mirabilis and Proteus vulgaris bacteria (SEM) | Macro & Micro: Up Close and Personal | Pinterest | Microbiology, Bacteria shapes and Fungi. https://www.pinterest.com › pin.
Certain virulence factors such as adhesin, motility and biofilm formation have been identified in Proteus species that has a positive correlation with risk of infection. After attachment of Proteus with urothelial cells, interleukin 6 and interleukin 8 secreted from the urothelial cells causes apoptosis and mucosal endothelial cell desquamation. Urease production of proteus also augments the risk of UTI. Urease production, together with the presence of bacterial motility and fimbriae or pili, as well as adhesins anchored directly within bacterial cell membrane may favor the upper urinary tract infection. Once firmly attached on the uroepithelium or catheter surface, bacteria begin to phenotypically change, producing exopolysaccharides that entrap and protect bacteria. These attached bacteria replicate and form microcolonies that eventually mature into biofilms [31, 32]. Once established, biofilms inherently protect uropathogens from antibiotic and the host immune response [33, 34]. Proteus mirabilis as with other uropathogens is capable of adapting to the urinary tract environment and acquiring nutrients. And this is accomplished by the production of degradative enzymes such urease and proteases, toxins such as Haemolysin Hpm A and iron nutrient acquisition proteins.
5.2.3. Laboratory diagnosis
The infection with Proteus can be diagnosed by taking a urine sample for microscopy and culture which is sufficient in most of the cases except in few cases where advanced diagnostic tools are used. If the urine is alkaline, it is suggestive of infection with Proteus sp. The diagnosis of Proteus is made on swarming motility on media, unable to metabolized lactose and has a distinct fishy door. Ultrasound or CT scan to identify renal stone (Struvite stone) or to visualized kidneys or surrounding structures. It will allow to exclude other possible problems, mimicking symptoms of urinary tract infection [35, 36].
5.3. Pseudomonas in CAUTI
5.3.1. Introduction
Pseudomonas is a gram-negative bacteria belonging to the family Pseudomonadaceae and containing 191 validly described species [37]. Because of their widespread occurrence in water and plant seeds, the pseudomonas was observed in early history of microbiology. Pseudomonas is flagellated, motile, aerobic organism with Catalase and oxidase-positive. Pseudomonas may be the most common nuclear or of ice crystals in clouds, thereby being of utmost importance to the formation of snow and rain around the world [38]. All species of Pseudomonas are strict aerobes, and a significant number of organisms can produce exopolysaccharides associated with biofilm formation [39]. Pseudomonas is an opportunistic human pathogen that is especially adept at forming surface associated biofilms. Pseudomonas causes catheter associated urinary tract infection(CAUTIs) through biofilm formation on the surface of indwelling catheters, and biofilm mediated infection including ventilator associated pneumonia, infections related to mechanical heart valves, stents, grafts, sutures, and contract lens associated corneal infection [40].
Pseudomonas is third ranking causes nosocomial UTI about 12%, where E. coli remain on the top [41]. CAUTI is directly associated with duration of catheterization. Within 2–4 days of catheterization 15–25% patients develop bacteriuria [42].
5.3.2. Structure and pathogenesis
Pseudomonas aeruginosa is a gram-negative, rod shaped, asporogenous and monoflagellated, noncapsular bacterium but many strains have a mucoid slime layer. Pseudomonas has an incredible nutritional versatility. Pseudomonas can catabolize a wide range of organic molecule including organic compounds such as benzoate. This, then make Pseudomonas a very ubiquitous microorganism and Pseudomonas is the most abundant organism on earth [43] (Figure 3).
Figure 3.
Gram stain picture and morphology of Pseudomonas aeroginosa. Adapted from Science News. A new antibiotic uses sneaky tactics to kill drug-resistant Pseudomonas aeruginosa illustration and Pseudomonas Aeruginosa Stock Photos & Pseudomonas Aeruginosa Stock Images—Alams. https://www.alamy.com › stock-photo.
Pseudomonas is widely distributed in nature and is commonly present in moist environment of hospitals. It is pathogenic only when introduce into areas devoid of normal defense such as disruption of mucous membrane and skin, usage of intravenous or urinary catheters and neutropenia due to cancer or in cancer therapy. Its pathogenic activity depends on its antigenic structure, enzymes and toxins [44]. Among the enzymes Catalase, Pyocyanin, Proteases, elastase, haemolysin, Phospholipase C, exoenzyme S and T and endotoxin and endotoxin A play role in disease process and as well as immunosuppression. Pseudomonas can infect almost any organ or external site. Pseudomonas in invasive and toxigenic. It attached to and colonized the mucous membrane of skin. Pseudomonas can invade locally to produce systemic disease and septicemia. Pseudomonal UTs are usually hospital acquired and are associated with catheterization, instrumentation and surgery. These infections can involve the urinary tract through an ascending infection or through bacteriuria spread. These UTIs may be a source of bacteraemia or septicemia [45].
5.3.3. Laboratory diagnosis
Identification of bacterium with microscopy is simple method of identification of pseudomonas. Culture and antibiotic sensitivity pattern can be done in most laboratory media commonly on blood agar or eosin-methylthionine blue agar. Pseudomonas has inability to ferment lactose and has a positive oxidase reaction. Fluorescence under UV light is helpful in early identification of colonies. Fluorescence is also used to suggest the presence of pseudomonas in wounds [46].
5.4. CAUTI with Klebsiella
5.4.1. Introduction
Urinary catheters are standard medical devices utilized in both hospital and nursing home settings are associated with a high frequency of catheter-associated urinary tract infections (CAUTI). The contribution of Klebsiella spp. in CAUTI is near about 7.7% [47].
5.4.2. Structure and pathogenesis
Klebsiella pneumoniae is a gram-negative pathogenic bacterium, is part of the Enterobacteriaceae family. It has got polysaccharide capsule attached to the bacterial outer membrane, and it ferments lactose. Klebsiella species are found ubiquitously in nature, including in plants, animals, and humans. They are the causative agent of several types of infections in humans. It has a large accessory genome of plasmids and chromosomal gene loci. This accessory genome divides K. pneumoniae strains into opportunistic, hyper virulent, and multidrug-resistant groups [48] (Figure 4).
Figure 4.
Gram stain picture and morphology of Klebsiella pneumonie. Adapted from studyblue.com. Microbio Lab Practical I—Microbiology 101 with Johnson at University of Vermont—StudyBlue. Study 368 Microbio Lab Practical I flashcards from Tess H. on StudyBlue and Klebsiella Pneumoniae Stock Photos and Pictures. Getty Images https://www.gettyimages.com › photos.
The source of Klebsiella causing CAUTI can be endogenous typically via meatal, rectal, or vaginal colonization or exogenous, such as via equipment or contaminated hands of healthcare personnel. They typically migrate along the outer surface of the indwelling urethral catheter, until they enter the urethra.
Migration of the Klebsiella along the inner surface of the indwelling urethral catheter occurs much less frequently, compared with along the outer surface Internal (intraluminal) bacterial ascension occurs by Klebsiella tend to be introduced when opening the otherwise closed urinary drainage system, ascend from the urine collection bag into the bladder via reflux, biofilm formation occurs.
A critical step in progression to CAUTI by Klebsiella is to adhere to host surfaces, which is frequently achieved using pili (fimbriae) [49]. Pili are filamentous structures extending from the surface of Klebsiella. They can be as long as 10 μm and between 1 and 11 nm in diameter. Among the two types of pili—type 1 (fim) pili and type 3 (mrk) pili, type 1 aids virulence by their ability to adhere with mucosal surfaces and type 3 pili strongly associated with biofilm production [50]. Both fim and mrk pili are considered part of the core genome [51]. It is thought that both types of pili play a role in colonization of urinary catheters, leading to CAUTI [52]. In addition to fim and mrk pili, a number of additional usher-type pili have been identified in Klebsiella with an average of ~8 pili clusters per strain. Based on varying gene frequencies, some of these appear to be part of the accessory genome. Immediately after catheterization Klebsiella starts biofilm production on the inner as well as outer surface of the catheter and on urothelium. Biofilm augments migration of Klebsiella into urethra and urinary bladder. Biofilm formation on the catheter surface by Klebsiella pneumoniae causes severe problem. Type 1 and type 3 fimbriae expressed by K. pneumoniae enhance biofilm formation on urinary catheters in a catheterized bladder model that mirrors the physicochemical conditions present in catheterized patients. These two fimbrial types does not is expressed when cells are grown planktonically. Interestingly, during biofilm formation on catheters, both fimbrial types are expressed, suggesting that they are both important in promoting biofilm formation on catheters [53]. The biofilm life cycle illustrated in three steps: initial attachment events with inert surfaces type 1 and type 3 fimbriae encoded by the mrk ABCDF gene cluster within K. pneumoniae promotes biofilm formation [54, 55]. Detachment events by clumps of Klebsiella or by a ‘swarming’ phenomenon within the interior of bacterial clusters, resulting in so-called ‘seeding dispersal’.
Modifiable risk factor are prolonged catheterization, lack of adherence to aseptic catheter care, insertion of the indwelling urethral catheter in a location other than an operating room, presence of a urethral stent, feecal incontinence. Non-modifiable risk factor—renal disease (i.e., serum creatinine >2 mg/dL), diabetes mellitus, older age (i.e., age > 50 years old), female sex, malnutrition and severe underlying illness [53]. For infection several virulence factors such as surface factors (fimbriae, adhesins, and P and type 1 pili) and extracellular factors toxins, siderophores, enzymes, and polysaccharide coatings are necessary for initial adhesion with colonization of host mucosal surfaces for tissue invasion overcoming the host defense mechanisms, and causing chronic infections [55].
5.4.3. Laboratory diagnosis
Diagnosis of klebsiella infection is by isolation and laboratory identification of bacterium from urine or biofilm. Laboratory diagnosis can be done by culture of specimen—urine or catheter biofilm in blood agar, MacConkey’s agar. Specific ELISA, latex agglutination tests, PCR and other immunological-based detection methods are sophisticated alternatives for diagnosis of klebsiella. Determination of a gene on capsule of Klebsiella is rapid and simple method for the determination of the K types of most K. pneumoniae clinical isolates [56].
5.5. CAUTI with Enterobacter
5.5.1. Introduction
Enterobacter species, particularly Enterobacter cloacae and Enterobacter aerogenes, are important nosocomial pathogens responsible for about 1.9–9% CAUTI, rarely causes bacteremia [57, 58]. Enterobacter cloacae exhibited the highest biofilm production (87.5%) among isolated pathogens [53].
5.5.2. Structure and pathogenesis
Enterobacter bacteria are motile, rod-shaped cells, facultative anaerobic, non-spore-forming, some of which are encapsulated belonging to the family Enterobacteriaceae. They are important opportunistic and multi-resistant bacterial pathogens. As facultative anaerobes, some Enterobacter bacteria ferment both glucose and lactose as a carbon source, presence of ornithine decarboxylase (ODC) activity and the lack of urease activity. In biofilms they secrete various cytotoxins (enterotoxins, hemolysins, pore-forming toxins. Though it is microflora in the intestine of humans, it is pathogens in plants and insects. Amp C β-lactamase production by E. cloacae is responsible for cephalosporin resistance. They possess peritrichous, amphitrichous, lophotrichous, polar flagella. E. aerogenes flagellar genes and its assembly system have been acquired in bloc from the Serratia genus [59] (Figure 5).
Figure 5.
Gram stain picture and morphology of Enterobacter species. Adapted from Gram Stain Kit | Microorganism Stain | abcam.comAdwww.abcam.com/ and Science Prof Online. Gram-negative Bacteria Images: photos of Escherichia coli, Salmonella & Enterobacter and Enterobacter aerogenes | Gram-negative microorganism—HPV Decontamination | Hydrogen Peroxide Vapour—Bioquellhealthcare.bioquell.com › microbiology.
5.5.3. Laboratory diagnosis
The most important test to document Enterobacter infections is culture. Direct gram staining of the specimen is also useful. In the laboratory, growth of Enterobacter isolates is occurs in 24 h or less; Enterobacter species grow rapidly on selective (i.e., MacConkey) and nonselective (i.e., sheep blood) agars.
5.6. CAUTI with Enterococcus
5.6.1. Introduction
Enterococci are gram-positive facultative anaerobic cocci, two species are common commensal organisms in the intestines of humans: Enterococcus faecalis (90–95%) and Enterococcus faecium (5–10%) [60]. Though normally a gut commensal, these organisms are commonly responsible for nosocomial infection of urinary tract, biliary tract and blood, particularly in intensive care units (ICU) [61]. E. coli is usually the most frequent species isolated from bacteremic catheter associated urinary tract infections (CAUTI). However, Enterococcus spp. (28.4%) and Candida spp. (19.7%) were also reported to be most common [62]. In another study, E. coli was found the commonest (36%) followed by Enterococcus spp. (25%), Klebsiella species (20%) and Pseudomonas spp. (5%) [63].
5.6.2. Structure and pathogenesis
The most important cause of bacteriuria is the formation of biofilm along the catheter surface [64]. Enterococcus is gram positive bacteria often found in pairs or short chains. Broadly, Enterococcus is in two groups—faecalis and non-faecalis (E. gallinarum and E. casseliflavus). Enterococcus faecalis formerly classified as part of the group D Streptococcus is a gram-positive, commensal bacterium inhabiting the gastrointestinal tracts of humans and other mammals, survive harsh environmental conditions including drying, high temperatures, and exposure to some antiseptics [65]. E. faecalis has the important characteristics of complex set of biochemical reactions, including fermentation of carbohydrates, hydrolysis of arginine, tolerance to tellurite, and motility and pigmentation. Presence of the catheter itself is essential for E. faecalis persistence in the bladder, E. faecalis depends on the catheter implant for persistence via an unknown mechanism that more than likely involves its ability to produce biofilms on the silicone tubing and immune-suppression [66].
E. faecalis produce a heteropolymeric extracellular hair-like fimbrial structure called the endocarditis- and biofilm-associated pilus-Ebp, having three components the organelle (EbpC), a minor subunit that forms the base of the structure (EbpB) and a tip-located adhesin (EbpA) [67]. EbpA is responsible for adhesion in urothelial and catheter surface for biofilm production (Figure 6).
Figure 6.
Morphology of Enterococcus. Adapted from Science Photo Library/Alamy Stock Photo Image ID: F6YBC3.
5.6.3. Laboratory diagnosis
Urine sample and biofilm microscopy can identify this gram positive organism. Culture yields the growth of E. faecalis in appropriate media. Advanced diagnostic methods like immunological-based detection methods and PCR are rarely needed for diagnosis.
5.7. CAUTI with Candida
5.7.1. Introduction
One of the common causes of catheter associated urinary tract infection is fungal infection. Bacterial infections are accounted for 70.9% of catheter associated urinary infection. E. coli is the most commonly isolated organism (41.6%) whereas fungal infections are accounted for 16.6% and mixed fungal and bacterial infections accounted for 12.5% [68]. The National nosocomial infections surveillance (NNIS) data indicated that C. albicans caused 21% of catheter-associated urinary tract infections, in contrast to 13% of non-catheter-associated infections [69]. In one study 24% of the cases showing fungal yeast growth. Candida spp. was the commonest. Non-albicans Candida (86%) isolated more commonly than Candida albicans (14%) [70]. Candida are commensals, and to be pathogenic, interruption of normal host defenses is crucial which is facilitated in conditions like immunocompromised states as AIDS, diabetes mellitus, prolonged broad spectrum antibiotic use, indwelling devices, intravenous drug use and hyperalimentation fluids [71]. Diabetes mellitus has been reported as the most common risk factor for fungal infection [72, 73]. The duration of catheterization is also an important risk factor as the duration increases the incidence of fungal infection is increased [74].
5.7.2. Structure and pathogenesis
Candida albicans is an oval, budding yeast, which is a member of the normal flora of mucocutaneous membrane. Twenty species of Candida yeasts can cause in human infection but most common is Candida albicans. Sometimes it can gain predominance and can produce disease. Other candida species that can cause disease occasionally are Candida parapsilosis, Candida tropicalis and Candida krusei [75]. Although Candida albicans are common isolates in CAUTI, Candida tropicalis is increasingly reported in CAUTI [76]. The majority of Candida albicans infections are associated with biofilm formation on host or abiotic surfaces such as indwelling medical devices, which carry high morbidity and mortality [63, 77]. Several factors and activities contribute to the pathogenesis of this fungus which mediate adhesion to and invasion into host cells, which are in sequences are the secretion of hydrolases, the yeast-to-hypha transition, contact sensing and thigmotropism, biofilm formation, phenotypic switching and a range of fitness attributes [78] (Figure 7).
Figure 7.
Morphology of Candida albicans. Adapted from biomedik8888, Aug 24, 2011. http://www.BioMedik.com.au3.
5.7.3. Laboratory diagnosis
Urine and materials removed from catheter are needed. Microscopic examinations of gram-stained specimen showed pseudohyphae and budding cells. Culture on Sabouraud’s agar at room temperature and at 37°C showed typical colonies and budding pseudomycelia [79].
5.8. CAUTI with Serratia marcescens
It is facultative anaerobic bacilli gram-negative rod of Enterobacteriaceae family considered opportunistic human pathogen but not a component of human facial flora. It is capable of producing a pigment called prodigiosin, which ranges in color from dark red to pale pink. It is ubiquitously spent in nature and has preference for damp conditions. Though previously known as nonpathogenic, but since 1970s it is associated with multi drug resistant infection due to presence of R factor—a plasmid. A study in Japan showed 6.8% incidence of UTI with this organism [80]. It also causes bacteraemia rarely. Diagnosis is confirmed by culture of the urine specimen or catheter biofilm. Automated bacterial identification systems and Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) is the other modality for diagnosis of serratia as well as other enterobacteriaceae [81].
5.9. CAUTI with Delftia tsuruhatensis
This non-fermentative gram-negative rod discovered as plant growth-promoting bacterium and potential biocontrol agent against plant pathogens. Infection with this uncommon organism in CAUTI occurs in combination with commonest bacteria E. coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. D. tsuruhatensis and E. coli coexist and tend to co-aggregate over time and also cooperate synergistically [82]. D. tsuruhatensis metabolized citric acid more rapidly leaving more uric acid available in the medium to be used by E. coli for dynamic growth of both organisms. Identification of this organism is not confirmatory with culture, so molecular methods are more reliable [83].
5.10. CAUTI with Achromobacter xylosoxidans
Achromobacter denitrificans is gram negative bacterium formerly known as Alcaligenes denitrificans. Infection with this organism predominantly observed in elderly patients with predisposing factors as urological abnormalities, malignancies and immune-suppression. Rarely it causes bacteraemia. This bacterium has high level of antibiotic resistance [84].
In polymicrobial biofilm, Achromobacter xylosoxidans cohabits with common organisms E. coli, Pseudomonas aeruginosa and Klebsiella pneumoniae. Diagnosis is by bacterial culture and molecular methods.
5.11. CAUTI with Staphylococci
Staphylococci (methicillin-sensitive Staphylococcus aureus [MSSA] and methicillin-resistant S. aureus [MRSA], Staphylococcus saprophyticus. These are the common gram positive bacteria usually responsible for skin and soft tissue infections but rarely cause CAUTI and bacteraemia [85].
The incidence of Staphylococcal UTI as well as CAUTI is increasing and the organisms carry wide variety of multidrug-resistant genes on plasmids, which augment spread of resistance among other species [86].
Diagnosis is easy, gram stain of the sample, culture is sufficient. Advanced techniques rarely needed (Figure 8).
Figure 8.
Morphology of Staphylococcus aureus. Adapted from abcam.comAdwww.abcam.com/ pharmacist-driven intervention improves care of patients with S aureus Bacteremia/Staph aureus. Nebraska Medicine https://asap.nebraskamed.com.
6. Conclusion
CAUTI is one of the most nosocomial Infection worldwide resulting from rational as well as sometimes irrational use of indwelling urinary catheter. Cause of CAUTI is formation of pathogenic biofilm commonly due to UPEC, Proteus, Klebsiella, Pseudomonas, Enterobacter rarely Candida and other uncommon opportunistic organisms. CAUTI has got high impact on morbidity and mortality as biofilm producing organisms are more antibiotic resistant. Antibiotic resistance is a global problem. Early detection of CAUTI is simple by examination of urine and catheter biofilm with microscopy as well as culture with antibiogram. It is easy and cost effective with early diagnosis and treatment for good clinical outcome. Advanced and sophisticated methods like Immunomagnetic separation, specific ELISA, colony immunoblot assays and PCR for diagnosis of CAUTI is seldom necessary.
\n',keywords:"UTI, catheterization, CAUTI, biofilm",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/62973.pdf",chapterXML:"https://mts.intechopen.com/source/xml/62973.xml",downloadPdfUrl:"/chapter/pdf-download/62973",previewPdfUrl:"/chapter/pdf-preview/62973",totalDownloads:1408,totalViews:1131,totalCrossrefCites:0,dateSubmitted:"March 5th 2018",dateReviewed:"July 9th 2018",datePrePublished:"November 5th 2018",datePublished:null,dateFinished:null,readingETA:"0",abstract:"Urinary tract infection (UTI) is common ailment worldwide with female predominance. Catheter associated urinary tract infection (CAUTI) is the most common healthcare related infection commonly used in urinary obstruction and incontinence in critically ill patients with prolonged indwelling catheterization means more than 30 days, which is almost invariable in all patients within 14 days of catheterization which increases morbidity and mortality and treatment expenses. Approximately 80% of nosocomial UTI is CAUTI. CAUTI may be asymptomatic and symptomatic. 2–4% cases may develop bacteraemia. Organisms responsible for CAUTI is similar to UTI as Escherichia coli the commonest than proteus, Pseudomonas, Klebsiella, Enterobacter, Enterococci, Candida, Serratia and rarely with Delftia tsuruhatensis, Achromobacter xylosoxidans and few others. CAUTI can be multibacterial. In CAUTI infective organisms form biofilm and propagate from there. E. coli is the most common isolate of CAUTI but Enterobacter cloacae exhibit highest biofilm production. CAUTI organisms are more antibiotic resistance than UTI. Even due to extensive use of antibiotics now Extended Spectrum Beta Lactamase (ESBL) producing CAUTI organisms are isolated from catheter biofilm.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/62973",risUrl:"/chapter/ris/62973",signatures:"Md. Mahabubul Islam Majumder, Tarek Ahmed, Saleh Ahmed and Ashiqur Rahman Khan",book:{id:"7452",title:"Microbiology of Urinary Tract Infections",subtitle:"Microbial Agents and Predisposing Factors",fullTitle:"Microbiology of Urinary Tract Infections - Microbial Agents and Predisposing Factors",slug:"microbiology-of-urinary-tract-infections-microbial-agents-and-predisposing-factors",publishedDate:"February 13th 2019",bookSignature:"Payam Behzadi",coverURL:"https://cdn.intechopen.com/books/images_new/7452.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"45803",title:"Ph.D.",name:"Payam",middleName:null,surname:"Behzadi",slug:"payam-behzadi",fullName:"Payam Behzadi"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. General information about CAUTI",level:"1"},{id:"sec_2",title:"2. The collection of specimens",level:"1"},{id:"sec_3",title:"3. Microbiologic diagnosis of CAUTI",level:"1"},{id:"sec_4",title:"4. Other laboratory tests",level:"1"},{id:"sec_5",title:"5. Microorganisms causing CAUTI",level:"1"},{id:"sec_5_2",title:"5.1. CAUTI with E. coli",level:"2"},{id:"sec_5_3",title:"5.1.1. Introduction",level:"3"},{id:"sec_6_3",title:"5.1.2. Structure and pathogenesis",level:"3"},{id:"sec_7_3",title:"5.1.3. Laboratory diagnosis",level:"3"},{id:"sec_9_2",title:"5.2. Proteus in CAUTI",level:"2"},{id:"sec_9_3",title:"5.2.1. Introduction",level:"3"},{id:"sec_10_3",title:"5.2.2. Structure and pathogenesis",level:"3"},{id:"sec_11_3",title:"5.2.3. Laboratory diagnosis",level:"3"},{id:"sec_13_2",title:"5.3. Pseudomonas in CAUTI",level:"2"},{id:"sec_13_3",title:"5.3.1. Introduction",level:"3"},{id:"sec_14_3",title:"5.3.2. Structure and pathogenesis",level:"3"},{id:"sec_15_3",title:"5.3.3. Laboratory diagnosis",level:"3"},{id:"sec_17_2",title:"5.4. CAUTI with Klebsiella",level:"2"},{id:"sec_17_3",title:"5.4.1. Introduction",level:"3"},{id:"sec_18_3",title:"5.4.2. Structure and pathogenesis",level:"3"},{id:"sec_19_3",title:"5.4.3. Laboratory diagnosis",level:"3"},{id:"sec_21_2",title:"5.5. CAUTI with Enterobacter",level:"2"},{id:"sec_21_3",title:"5.5.1. Introduction",level:"3"},{id:"sec_22_3",title:"5.5.2. Structure and pathogenesis",level:"3"},{id:"sec_23_3",title:"5.5.3. Laboratory diagnosis",level:"3"},{id:"sec_25_2",title:"5.6. CAUTI with Enterococcus",level:"2"},{id:"sec_25_3",title:"5.6.1. Introduction",level:"3"},{id:"sec_26_3",title:"5.6.2. Structure and pathogenesis",level:"3"},{id:"sec_27_3",title:"5.6.3. Laboratory diagnosis",level:"3"},{id:"sec_29_2",title:"5.7. CAUTI with Candida",level:"2"},{id:"sec_29_3",title:"5.7.1. Introduction",level:"3"},{id:"sec_30_3",title:"5.7.2. Structure and pathogenesis",level:"3"},{id:"sec_31_3",title:"5.7.3. Laboratory diagnosis",level:"3"},{id:"sec_33_2",title:"5.8. CAUTI with Serratia marcescens",level:"2"},{id:"sec_34_2",title:"5.9. CAUTI with Delftia tsuruhatensis",level:"2"},{id:"sec_35_2",title:"5.10. CAUTI with Achromobacter xylosoxidans",level:"2"},{id:"sec_36_2",title:"5.11. CAUTI with Staphylococci",level:"2"},{id:"sec_38",title:"6. Conclusion",level:"1"}],chapterReferences:[{id:"B1",body:'Florece-Mireles AL, Waslker JN, Caparon M, Hultgren SJ. Urinary tract infections: Epidemiology, mechanisms of infection and treatment options. Nature Reviews Microbiology. 2015;13(5):269-264. DOI: 10.1038/nrmicro3432'},{id:"B2",body:'Esposito S, Noviello S, Leone S. Catheter-associated urinary tract infections: Epidemiology and prevention. Le Infezioni in Medicina. 2008;16(3):130-143'},{id:"B3",body:'Nicolle LE. Catheter associated urinary tract infections. Antimicrobial Resistance and Infection Control. 2014;3:23. DOI: 10.1186/2047-2994-3-23'},{id:"B4",body:'Parida S, Mishra SK. Urinary tract infections in the critical care unit: A brief review. Indian Journal of Critical Care Medicine. 2013;17(6):370-374. 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DOI: 10.3390/pathogens5040065'},{id:"B56",body:'Brisse S, Passet V, Haugaard AB, et al. wzi gene sequencing, a rapid method for determination of capsular type for Klebsiella strains. Journal of Clinical Microbiology. 2013;51(12):4073-4078. DOI: 10.1128/JCM.01924-13'},{id:"B57",body:'Afzal S, Ashraf M, Bukhsh A, et al. Efficacy of anti-microbial agents with ascorbic acid in catheter associated urinary tract infection. Journal of Infectious Diseases & Preventive Medicine. 2017;5:3. ISSN: 2329-8731. DOI: 10.4172/2329-8731.100016'},{id:"B58",body:'Sabir N, Ikram A, Zaman G, et al. Bacterial biofilm-based catheter-associated urinary tract infections: Causative pathogens and antibiotic resistance. American Journal of Infection Control. 2017;45(10):1101-1105. DOI: 10.1016/j.ajic.2017.05.009 Epub 2017 Jun 16'},{id:"B59",body:'Bhani D, Bachhiwal R, Sharma R, Maheshwari RK. 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Candida albicans pathogenicity mechanisms. Virulence. 2013;4(2):119-128'},{id:"B78",body:'Deorukhkar SC, Saini S, Raytekar NA, Sebastian MD. Catheter associated urinary tract candida infections in intensive care unit patients. Journal of Clinical Microbiology and Biochemical Technology. 2016;2(1):015-017'},{id:"B79",body:'Tsui C, Kong EF, Jabra-Rizk MA. Pathogenesis of Candida albicans biofilm. Pathogens and Disease. 2016;74(4):ftw018. DOI: 10.1093/femspd/ftw018'},{id:"B80",body:'Ishikawa K, Matsumoto T, Yasuda M, Uehara S, Muratani T, et al. The nationwide study of bacterial pathogens associated with urinary tract infections conducted by the Japanese Society of Chemotherapy. Journal of Infection and Chemotherapy. 2011;17(1):126-138 Epub 2010 Dec 21'},{id:"B81",body:'Rodriguesa NMB, Bronzatoa GF, Santiago GS, et al. The Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) identification versus biochemical tests: A study with enterobacteria from a dairy cattle environment Braz. Journal of Microbiology. 2017;48(1). DOI: 10.1016/j.bjm.2016.07.025'},{id:"B82",body:'Preiswerk B, Ullrich S, Speich R, Bloemberg GV, Hombach M. Human infection with Delftia tsuruhatensis isolated from a central venous catheter. Journal of Medical Microbiology. 2011;60:246-248. DOI: 10.1099/jmm.0.021238-0'},{id:"B83",body:'Azevedo AS, Almeida C, Gomes LC, Ferreira C, Mergulhão FJ, Melo LF, Azevedo NF. An in vitro model of catheter-associated urinary tract infections to investigate the role of uncommon bacteria on the Escherichia coli microbial consortium. Biochemical Engineering Journal. 2017;118:64-69'},{id:"B84",body:'Tena D, Praetorius AG, Balsalobre MP, Bisquert J. Urinary tract infection due to Achromobacter xylosoxidans. Report of 9 cases. Infectious Diseases. 2008;40(2):84-87. DOI: 10.1080/00365540701558714'},{id:"B85",body:'Romero-Vivas J, Rubio M, Fernandez C, Picazo JJ. Mortality associated with nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus. Clinical Infectious Diseases. 1995;21(6):1417-1423. DOI: 10.1093/clinids/21.6.1417'},{id:"B86",body:'Looney AT, Redmond EJ, Davey NM, et al. Methicillin-resistant Staphylococcus aureus as a uropathogen in an Irish setting. Medicine (Baltimore). 2017;96(14):e4635. DOI: 10.1097/MD.0000000000004635'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Md. Mahabubul Islam Majumder",address:"mahabubmazumder@yahoo.com",affiliation:'
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Openness - We communicate honestly and transparently. We are open to constructive criticism and committed to learning from it.
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