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Contaminated infant formula suspected in two Cronobacter infections
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Health officials emphasize the importance of WHO guidelines for preparing powdered infant formula and suggest improvements to the manufacturing process in a recent Morbidity and Mortality Weekly Report after investigators identified Cronobacter spp. in two infants.
Officials from the New Mexico Department of Health, the CDC and the FDA isolated Cronobacter spp. (formerly Enterobacter sakazakii) from a female infant aged 3.5 weeks at illness onset, who was discharged from the hospital with severe brain injury, hypertonicity and hydrocephalus 11.5 weeks after initial admission.
A second Cronobacter organism was identified via postmortem blood culture in an unrelated male infant aged 7 months, who died at home while taking a nap. Sudden infant death syndrome was determined to be the cause of death. Although no clear evidence of Cronobacter spp. infection exist, officials deemed the infant was colonized with the organism.
Consuming powdered infant formula was the only known risk factor in both cases, according to the report, but officials could not confirm sources for the bacteria.
Investigation revealed the presence of Cronobacter spp. in an opened canister of formula and a vacuum cleaner filter from the home of the male infant. Pulsed-field gel electrophoresis (PFGE) patterns were the same among the patient’s isolate and the one taken from the formula canister, but the PFGE pattern from the vacuum isolate was different.
Investigators could not determine the source of the female infant’s infection, as her formula was unavailable for testing and Cronobacter spp. was not isolated from the household surfaces tested.
“Cronobacter spp. are a rare cause of infant septicemia and meningitis with 40% mortality and often are associated with powdered infant formula,” the researchers wrote. The researchers advocated for universal adoption of WHO preparation guidelines, which include reconstituting formula “with water hot enough to inactivate Cronobacter organisms.”
Additional suggestions for reducing potential transmission include manufacturing sterile powdered infant formula and developing packaging that would prevent introduction of the organism from contaminated hands, scoops or other items. Breast-feeding infants whenever possible is also recommended.