Risk Factors for Multiple Infections with Salmonella, Shigella, and Campylobacter in Single Individuals Identified in Israel between 1999 and 2020: A Case-Case Control Study.

BACKGROUND

Salmonella, Shigella, and Campylobacter are highly prevalent among children. Reports on risk factors of patients infected with all three pathogens, not simultaneously, are scarce.

OBJECTIVES

To identify risk factors for multiple infection with Salmonella, Shigella, and Campylobacter in the same child.

METHODS

Using the Israel Sentinel Laboratory-Based Surveillance Network, we conducted a retrospective observational case-case-control study among children aged 0-9 years. A case was defined as a child infected with Salmonella, Shigella, and Campylobacter at different occasions between January 1999 and December 2020. A control was defined as a child infected with a single pathogen once, during the same period. Logistic regression models were applied to determine the association between multiple infections and demographic characteristics.

RESULTS

We identified 109 cases (0.1%) infected with Salmonella, Shigella, and Campylobacter, and 86,511 controls (99.9%) infected with only one bacteria type. In a multivariable analysis, we showed that being Jewish (odds ratio [OR] 2.4, 95% confidence interval [95%CI] 1.3-4.4), having residency in Jerusalem (OR 3.2, 95%CI 1.3-7.7), or in the southern district (OR 3.7, 95%CI 1.5-8.8) were independent risk factors for multiple infection.

CONCLUSIONS

Although very rare, non-simultaneous infection with multiple bacteria does occur in Israel. National and local authorities should promote programs to encourage proper hygiene practices, which are culture-adjusted.