Campylobacter is the leading cause of bacterial gastroenteritis and dysentery in hospitalized children in the Western Galilee Region in Israel.

To The Editor : In their paper, Stein-Zamir et al. describe populationbased, age-specific epidemiological trends of enteric bacterial infections in children in the Jerusalem district in Israel during 1990–2008 [1]. Overall, during the study period Shigella was the leading bacterial pathogen, especially in children aged <5 years. Shigella infections were characterized by an endemicepidemic pattern. The incidence of Salmonella infection increased in the early 1990s and then declined after 2000. Campylobacter gastroenteritis rates increased steadily and by 2008 it became the leading cause of diagnosed bacterial enteric infection being particularly predominant in infants aged <6 months. Previous studies from Israel conducted in the 1990s demonstrated the infrequency of Campylobacter infections in children with gastroenteritis : Finkelstein et al. found Campylobacter in only 2% of hospitalized dysenteric children in one hospital in central Israel [2] and Lerman et al. found that only 1% of children with acute diarrhoea living in a kibbutz in central Israel had Campylobacter infection [3]. We recently conducted a retrospective study of all hospitalized children with gastroenteritis in the Western Galilee Hospital in Nahariya, Israel during 24 months in 2007–2009. The hospital serves a population of 500 000 people in the Western Galilee area in northern Israel. In the study, charts of hospitalized children with gastroenteritis of bacterial aetiology were identified and reviewed. We found 99 children admitted with bacterial gastroenteritis ; Campylobacter was identified in 61%, Shigella in 24%, and Salmonella in 16%. Of children with dysentery (n=63), Campylobacter was isolated in 72% whereas Shigella was isolated only in 19%. Campylobacter was the infecting cause in 94% of dysenteric children aged <1 year. We also identified nine young, afebrile infants aged <3 months with blood-streaked stools ; eight had stool cultures positive forCampylobacter [4]. Interestingly, in contrast to our findings, the recent European guidelines for the management of acute gastroenteritis in children state that Campylobacter is the most common bacterial pathogen beyond the age of 5 years, implicating different epidemiology of enteropathogens in children in Europe [5]. Our study supports the new trends among bacterial gastroenteritis pathogens in Israel, and especially for Campylobacter, demonstrated by Stein-Zamir et al. and does so in a different region of Israel, and in hospitalized children. This emphasizes the importance of Campylobacter in Israel as the main pathogen of bacterial gastroenteritis and dysentery, especially in young infants and calls for studies focusing on interventions to decrease the transmission of the pathogen to humans.