Parenteral Diarrhea and Pediatric Urinary Tract Infections: A Systematic Review

Background Parenteral diarrhea is non-infectious diarrhea associated with extraintestinal infections such as urinary tract infection (UTI), but evidence supporting this association is limited. We performed a systematic literature review to determine the reported frequency of UTI in pediatric patients who had diarrhea. Methods We searched electronic databases (PubMed, Scopus, Google Scholar, and CINAHL) to identify articles about diarrhea and UTI. We included English-language articles about studies of children (age, ≤5-years) who presented with diarrhea in which the frequency of culture-positive UTI was reported. We excluded studies that examined particular diets or specific pediatric patient populations presenting with diarrhea. Patient and study characteristics were extracted manually. Results The database search identified 32 articles. After excluding 25 articles and adding 3 articles identified during manual review of article references, there were 10 articles in the final review including 8 cohort and 2 case control studies. In all 10 studies combined, UTIs were observed in 172 of 1086 children who presented with diarrhea (15.8%), but the frequency of UTI varied between studies (range, 5 to 32%). Escherichia coli was the most common bacterial isolate from urine in all 9 studies that reported microbiology results. The stool and urine culture results (E. coli) were similar in 4 of the 6 studies that reported stool culture results. Conclusion In infants and children up to age 5-years, diarrhea may be associated with an UTI. In patients who have diarrhea of unknown cause, it may be prudent to consider an evaluation for a coexisting UTI.