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Contaminated breast pump linked to Cronobacter infection in preterm infant
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Health officials have identified a contaminated breast pump as the source of Cronobacter sakazakii infection in a premature infant in Pennsylvania, according to recently published data in MMWR.
Only one other reported case of this infection had been linked to a source other than formula contamination in infants.
“[The infant’s] clinical course in the neonatal intensive care unit was unremarkable until developed signs of sepsis at age 21 days,” Anna Bowen, MD, from the Division of Foodborne, Waterborne and Environmental Diseases in the National Center for Emerging and Zoonotic Infectious Diseases at the CDC, and colleagues wrote. “Despite treatment with ampicillin and cefepime, she developed seizures; brain imaging revealed liquefaction necrosis of the entire left cerebral hemisphere and right frontal lobe.”
The infant had also developed spastic cerebral palsy and required the use of both a ventriculoperitoneal shunt and a gastrostomy feeding tube.
Bowen and colleagues noted that the source of contamination remains unknown, but after testing, a breast pump kit used by the mother was found to not have been adequately cleaned or sanitized and became infected with C. sakazakii.
“Human milk is the ideal food for nearly all infants and is associated with decreased risk for many illnesses; however, microorganisms can multiply rapidly in expressed human milk,” the researchers wrote. “Although many women report good hygiene while expressing milk, expressed human milk is frequently contaminated with pathogens, most likely because of suboptimal hygiene practices associated with milk expression.”
Bacteria in unsanitary, unscrubbed breast pump
Within the first week after birth, the infant had received pasteurized donor human milk and expressed maternal milk. After the first week, she was fed expressed maternal milk that had been combined with a liquid human milk fortifier. All milk used from the mother was expressed at a bedside hospital breast pump and the mother’s personal breast pump during hospitalization. No powdered formulas were used.
C. sakazakii was cultured from various sources, including the valves of the personal breast pump kit on seven separate days before onset, 11 frozen expressed maternal milk samples and the drain of the kitchen sink. Additionally, two to five gram-negative bacteria were found in the expressed milk samples and in the personal breast pump kit. Isolates of the bacteria remain unknown in all tested items excluding the earliest collected maternal milk sample.
The personal breast pump had been cleaned by soaking in a wash basin with no scrubbing or sanitation process used on the device. The pump was later rinsed, air-dried and stored in a zip-top bag. The hospital kit received immediate washings and was air dried completely at the bedside.
Dangers of infection
Sepsis and severe meningitis are common among infants infected with C. sakazakii. Previously observed cases of infection had been tied to contaminated formula; however, other external sources, including food products and the environment, may be infected with the bacteria.
“[The] CDC has developed guidance to optimize breast pump hygiene. Clinicians should provide detailed recommendations about hygienic expression and handling of human milk to parents who plan to feed expressed maternal milk to their infants,” Bowen and colleagues wrote.
The researchers also suggest that places in which a mother may need to express milk, including hospitals and workplaces, should allow for hygienic expression and handling of human milk. — by Katherine Bortz
Disclosure: The researchers provide no relevant financial disclosures.
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