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Published on: February 17, 2023
Infection of Cronobacter sakazakii ST1 Producing SHV-12 in a Premature Infant Born from Triplet Pregnancy
Monika Lachowska1, Radosław Izdebski2, Paweł Urbanowicz2
1Department of Neonatology, Wrocław Medical University, 50-556 Wrocław, Poland.
Insights
A rare fatal Cronobacter sakazakii infection occurred in a premature infant fed human milk. This highlights the need for advanced diagnostics beyond traditional methods for neonatal sepsis cases.
Area of Science:
- Microbiology
- Neonatalogy
- Infectious Diseases
Background:
- Cronobacter sakazakii is a significant pathogen causing severe neonatal infections, typically linked to powdered infant formula.
- Invasive infections in neonates carry a high mortality rate, necessitating a thorough understanding of transmission routes.
Observation:
- A premature infant exclusively fed expressed human milk developed a fatal Cronobacter sakazakii infection.
- Despite identifying the pathogen in the infant's blood, extensive epidemiological screening of the mother, hospital environment, and milk samples yielded no bacterial source.
Findings:
- The infection was attributed to Cronobacter sakazakii ST1, a prevalent genotype in invasive infections.
- Phylogenetic analysis placed the isolate within the main cluster of ST1 organisms.
- The isolate possessed virulence factors, including an IncFIB-like molecule (pESA-3 family plasmid) and an ESBL phenotype due to the blaSHV-12 gene on an IncX3 plasmid.
Implications:
- This case underscores that human milk, while generally protective, is not inherently sterile and can potentially harbor pathogens.
- It emphasizes the critical need for whole-genome sequencing in routine diagnostic procedures for neonatal infections to identify transmission pathways and genetic virulence factors.
- The findings contribute valuable genetic insights into Cronobacter pathogenesis and infection control strategies.
Abstract:
Cronobacter sakazakii can cause severe life-threatening invasive infections in neonates, with a high mortality rate mostly associated with powdered infant formula consumption. The study describes a fatal C. sakazakii infection in premature infant fed only with expressed human milk. Despite the identification of etiological factor from patient's blood, the epidemiological investigation, including mother's skin, hospital surfaces, milk expressing devices, and milk samples, did not show bacterial contamination. The infection was caused by C. sakazakii ST1, being one of the leading genotypes reported in invasive infections. The phylogenetic analysis of the international collection of the ST1 organisms allowed us to identify the isolate as a member of the main cluster. The pathogenic potential of the isolate was augmented by the presence of IncFIB-like molecule representing virulence plasmids of pESA-3 family. Isolate presented ESBL phenotype associated with blaSHV-12 gene harboured by IncX3 plasmid. The described case gave valuable information to genetics of Cronobacter, and also urges the need of wider whole-genome sequencing implementation as a part of diagnostic procedure.
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