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Cronobacter species isolation in two infants - New Mexico, 2008

    MMWR. Morbidity and Mortality Weekly Report
    |October 31, 2009
    PubMed

    Insights

    Cronobacter infections, a rare but severe threat to infants, are linked to powdered infant formula (PIF). Safer PIF preparation and handling are crucial to prevent infant illness and death.

    Area of Science:

    • Microbiology
    • Public Health
    • Pediatrics

    Background:

    • Cronobacter spp. (formerly Enterobacter sakazakii) are infrequent but highly lethal pathogens in infants, causing septicemia and meningitis with a 40% mortality rate.
    • Historically, fewer than three cases per year globally have been reported since 1958.
    • The World Health Organization (WHO) has established guidelines for the safe preparation, handling, and storage of powdered infant formula (PIF) due to its non-sterile nature and repeated association with Cronobacter infections.

    Observation:

    • Two unrelated, non-hospitalized infants in New Mexico were diagnosed with Cronobacter infections in 2008.
    • One infant suffered severe brain injury and hydrocephalus, while the other tragically died.
    • Powdered infant formula consumption was identified as the sole risk factor in both cases by the New Mexico Department of Health (NMDOH).

    Findings:

    • Cronobacter spp. were not detected in sealed PIF canisters linked to the affected infants.
    • Pulsed-field gel electrophoresis (PFGE) revealed distinct genetic profiles between the clinical isolates from the two infants.
    • A Cronobacter organism isolated from an opened PIF canister consumed by the male infant was indistinguishable from his postmortem blood culture isolate.

    Implications:

    • These findings underscore the critical need for enhanced infant formula preparation education for caregivers.
    • Universal adherence to WHO guidelines for PIF preparation and handling is recommended to mitigate infection risks.
    • Continuous improvement in PIF manufacturing processes is essential to enhance product safety and prevent infant infections.

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