- Infants with identified Cronobacter infection should be admitted to the intensive care unit (ICU) / neonatal ICU.
- Airway, breathing, and circulation (ABC) should be assessed with appropriate interventions to remediate deficits.
Cronobacter sakazakii, formerly called Enterobacter sakazakii, is a gram-negative facultative anaerobe that can be found in dried foods such as powdered infant formula, powdered milk, dried teas, dried starches, and as a contaminant on breast pump and infant feeding equipment. Clinically significant infection is quite rare and can be seen in all age ranges, but it is most common in premature infants, infants younger than 2 months, and those with compromised immune systems. From 2002-2022, the US Centers for Disease Control and Prevention (CDC) received 76 reports of Cronobacter infections in infants. Infections with Cronobacter can lead to meningitis and bacteremia with sepsis. This is most common in young infants, with up to 40% of cases resulting in death. Cases of necrotizing enterocolitis have also been reported. In older individuals, C sakazakii has caused wound infections and urinary tract infections with significantly less mortality and morbidity.
While felt to be rare, the true incidence of Cronobacter infections is unknown due to the lack of reporting requirements. In 2024, infection with C sakazakii became a nationally notifiable condition.
Infections in infants present with fever or thermoinstability, excessive crying, poor feeding, and lethargy. Seizures have also been reported. Most infant infections result in meningitis, meningoencephalitis, or sepsis. Infection is less common in older children and adults with compromised immune systems and may present with wound or urinary tract infections.
Diagnosis is made by isolation of Cronobacter by culture from blood, wound, urine, or cerebrospinal fluid (CSF). Ideally, treatment is begun after cultures are obtained (if this can be done expeditiously and the patient is stable enough) with broad-spectrum intravenous (IV) antibiotics started as soon as possible. Antibiotic therapy is then honed based on sensitivity data. Multidrug resistant strains have been reported.
Infection can be prevented by breastfeeding instead of using powdered formula, proper hand washing, and sanitizing, cleaning, and storing infant feeding items safely. Highest-risk infants should be fed liquid formula because this has been sterilized as opposed to powdered formula, which is not sterile. Boiling water that has been left to cool for 5 minutes may be mixed with powdered formula to help kill potential bacterial contaminants; however, care must be taken to ensure it has cooled sufficiently to body temperature before feeding. This is not recommended for all formulas (see manufacturers' recommendations for reconstitution). Powdered formula should be fed to infants ideally within 2 hours of reconstitution and within 1 hour of starting the feed.
