Shigella in baby bottles of a Brazilian newborn nursery.

Key words: Shigella dysenteriae; multi-drug resistance; baby bottles. Copyright © 2015 de Moraes et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Dear Editor, Cronobacter spp. (formerly Enterobacter sakazakii as described) and Salmonella enterica are the most worrisome pathogens associated with infant formula, since there is clear evidence that their presence can result in severe disease in at-risk population who consume that food [1]. Many studies report the survival of Cronobacterspp. in infant milk formula (IMF), but a small number studies reported the detection of Salmonella or other Gram-negative bacteria [1,2]. Our work initially aimed at detecting the presence of Salmonella spp. in samples of utensils (baby bottles, spoons, teats, jars and trays) and reconstituted IMF from a infant formula preparation room (called lactary in Brazil) in the newborn nursery of a public hospital located in Rio de Janeiro, Brazil. None of the samples studied in this work yielded Salmonella, but further identification of the 44 colonies growing in selective media used for the detection of this pathogen revealed the occurrence of other Enterobacteriaceae species in IMF and utensils, as Acinetobacter baumannii-calcoaceticus and Enterobacter cloacae. However, the most surprising finding was the presence of five (11.4%) isolates obtained from baby bottles identified as Shigella dysenteriaetype 1, the most toxic of serotypes associated with shigellosis, an acute enteric infection [3]. Although not expected, the presence of this pathogenin baby bottles was not an isolated incident, since the studies by Fauziah et al. [4] showed the presence of Shigellas pp. in infant formulas prepared in nurseries of neonatal intensive care units. Foodborne infections caused by Shigella and some Salmonella species are responsible for millions of illnesses each year and infants are particularly susceptible to these organisms [5,6]. According to Jain and colleagues [3], shigellosis is still an important public health problem in developing and underdeveloped countries and the ingestion of Shigella dysenteriae in infant formulas can cause potentially devastating consequences to newborns. Baby bottles can be considered a potential route of Shigellas pp. transmission and a significant factor in the epidemiology of shigellosis, since poor sanitation and inadequate hygiene practices may facilitate the spread of enteric pathogens [4,7,8]. In a lactary, Shigella may easily spread to infants fed with IMF and antimicrobial treatment is required for the control of outbreaks …