Contaminación microbiólogica en fórmulas infantiles en polvo en dos hospitales de Honduras / Microbiological contamination in children's powdered formulas in two Honduran hospitals

OBJETIVOS: Determinar la existencia de contaminación por patógenos en fórmulas infantiles en polvo (FIP) procesadas en los dos hospitales públicos más grandes de Honduras y evaluar las condiciones de procesamiento de sus servicios de fórmulas infantiles (SFI). MÉTODOS: Estudio exploratorio realizado en dos etapas: ') Evaluación presencial de las condiciones de procesamiento de las FIP de los dos SFI; 2) Recolección y análisis de las muestras FIP para el aislamiento de Cronobacter spp. y enterobacterias. RESULTADOS: La evaluación de los SFI mostró debilidades en diferentes aspectos como infraestructura, almacenamiento, capacitación y registros. Cincuenta muestras fueron recolectadas en total de cinco marcas originarias de seis países. El 38% se encontraban en uso durante el muestreo y 62% fueron recolectadas de latas selladas. Se comprobó la presencia de Cronobacter spp. en 4% (2/50) del total de muestras, una proveniente de cada hospital. Se elaboró y entregó un manual de procesamiento de FIP a cada hospital participante. CONCLUSIONES: Existe contaminación de Cronobacter spp., Klebsiella y Acinetobacter en los dos hospitales hondureños; resultado similar a los estimados en Chile (5%) y Cuba (',6%). Es necesaria la implementación del manual de procesamiento FIP y el monitoreo de estos y otros microorganismos patógenos.

OBJECTIVES: Determine the existence of pathogen contamination in powdered infant formulas (PIF) processed in the two largest public hospitals in Honduras and evaluate the processing conditions of their infant formula services (IFS). METHODS: Exploratory study executed in two stages: ') faceto-face evaluation of the processing conditions of the PIF of the two IFS; 2) Collection and analysis of the PIF samples for Cronobacter spp. and Enterobacteriaceae isolation. RESULTS: The evaluation of the IFS showed weaknesses in different aspects such as infrastructure, storage, training and keeping records. In total, fifty samples were collected, representing five brands from six countries. Thirty eight percent of samples were collected from cans in use during sampling and 62% were collected from sealed cans. The presence of Cronobacter spp. was detected in 4% (2/50) of the total samples, one from each hospital. A PIF processing manual was prepared and delivered to each participating hospital. CONCLUSIONS: Contamination of Cronobacter spp., Klebsiella and Acinetobacter existed in two evaluated Honduran hospitals; results similar to others in Chile (5%) and Cuba ('.6%). It is necessary to implement the PIF processing manual and monitor these and other pathogenic microorganisms

Evaluation of commercial probiotic lactic cultures against biofilm formation by Cronobacter sakazakii

BACKGROUND/AIMS: Cronobacter sakazakii, an emergent pathogen is considered as a major concern to infants and neonates fed on reconstituted powdered infant milk formula. In conjunction with many other factors, biofilm forming capacity adds to its pathogenic potential. In view of the facts that infants are at highest risk to C. sakazakii infections, and emerging antibiotic resistance among pathogens, it is imperative to evaluate probiotic cultures for their efficacy against C. sakazakii. Therefore, pure probiotic strains were isolated from commercial probiotic products and tested for their antimicrobial and anti-biofilm activities against C. sakazakii. METHODS: A total of 6 probiotic strains were tested for their antibiotic susceptibility followed by antimicrobial activity using cell-free supernatant (CFS) against C. sakazakii. The inhibitory activity of CFS against biofilm formation by C. sakazakii was determined using standard crystal violet assay and microscopic observations. RESULTS: All the probiotic strains were sensitive to ampicillin, tetracycline, vancomycin and carbenicillin whereas most of the strains were resistant to erythromycin and novobiocin. Four of the 6 probiotic derived CFS possessed antimicrobial activity against C. sakazakii at a level of 40 μL. A higher biofilm inhibitory activity (>80%) was observed at initial stages of biofilm formation with weaker activity during longer incubation upto 48 hours (50%–60%). CONCLUSIONS: The study indicated the efficacy of isolated commercial probiotics strains as potential inhibitor of biofilm formation by C. sakazakii and could be further explored for novel bioactive molecules to limit the emerging infections of C. sakazakii.

Two Cases of Multi-antibiotic Resistant Cronobacter spp. Infections of Infants in China / 生物医学与环境科学（英文）

Infections by Cronobacter spp. are hazardous to infants since they can lead to neonatal meningitis, bacteremia, and necrotizing enterocolitis. Cronobacter spp. are frequently resistant to β-lactam derivatives, macrolides, and aminoglycosides. In addition, multi-resistant strains have also been detected. In China, the isolation rate of Cronobacter spp. from commercial powdered infant formula (PIF) or follow-up formula (FUF) is relatively high. Nevertheless, clinical cases of Cronobacter infection have been ignored to date. Here we describe two cases of Cronobacter infection detected at the Wuhan Women and Children Medical Care Center Hospital (Wuhan City, China). We provide the genomic analysis of the isolates and the antibiotic-resistance profiles of the two strains. The Cronobacter strains identified in this study were not susceptible to third-generation cephalosporins, aminoglycoside, and/or trimethoprim-sulfamethoxazole. Whole genome sequencing revealed various genes known to encode antibiotic resistance. Future studies are needed to determine whether the genes predicted in this study are functional. As with Enterobacter spp., the antibiotic resistance of Cronobacter is a serious issue that requires more attention.

Study on identification of Cronobacter spp.species in 11 areas in China / 中华流行病学杂志

Objective To compare different methods on the identification of Cronobacter (C.) spp.species and to choose an optimum one.Methods Biochemical test,16S rRNA and fusA sequencing methods were carried out.Results When using the biochemical test,105 strains showed six different conditions but C.turicensis and C.universalis could not be effectively identified.Under the 16S rRNA sequencing analysis,all the strains were divided into 5 groups but C.sakazakii and C.malonaticus were tangled.Finally,all the strains were identified into 58 C.sakazakii,30 C.malonaticus,11 C.dublinensis,5 C.turicensis,1 C.muytjensii,under the fusA sequencing analysis.Conclusion Currently,fusA sequencing analysis seemed an effective method for identifying the species of Cronobacter.Since fusA sequencing analysis method was less intuitive,another method for rapid testing should be developed.

Study on identification of Cronobacter spp.species in 11 areas in China / 中华流行病学杂志

Objective To compare different methods on the identification of Cronobacter (C.) spp.species and to choose an optimum one.Methods Biochemical test,16S rRNA and fusA sequencing methods were carried out.Results When using the biochemical test,105 strains showed six different conditions but C.turicensis and C.universalis could not be effectively identified.Under the 16S rRNA sequencing analysis,all the strains were divided into 5 groups but C.sakazakii and C.malonaticus were tangled.Finally,all the strains were identified into 58 C.sakazakii,30 C.malonaticus,11 C.dublinensis,5 C.turicensis,1 C.muytjensii,under the fusA sequencing analysis.Conclusion Currently,fusA sequencing analysis seemed an effective method for identifying the species of Cronobacter.Since fusA sequencing analysis method was less intuitive,another method for rapid testing should be developed.

Identificação de Cronobacter spp. em queijos e perfil de suscetibilidade antimicrobiana / Identification of Cronobacter spp. in cheeses and the antimicrobial susceptibility profile

Cronobacter spp. é um patógeno oportunista que pode causar infecções em indivíduos de qualquer idade, cuja incidência é maior em neonatos, pacientes imunocomprometidos e idosos. Neste estudo Cronobacter spp. foi pesquisado em 90 amostras de queijos (30 do tipo Minas Frescal, 30 do tipo Prato e 30 do tipo Prato fatiado). As espécies isoladas foram identificadas, e foi avaliado o perfil de suscetibilidade a antimicrobianos. A pesquisa foi realizada utilizando-se pré-enriquecimento em água peptonada tamponada, enriquecimento seletivo no caldo lauril sulfato triptose contendo vancomicina, isolamento no meio Enterobacter sakazakii Isolation Agar e identificação no Vitek 2.0. As espécies foram identificadas por meio de múltipla PCR com alvo no gene cgcA. O antibiograma foi realizado pela técnica de difusão em ágar (Kirby-Bauer). Cronobacter spp. foi isolada em uma (1,1 %) amostra de queijo tipo Minas Frescal, identificada como C. sakazakii que apresentou sensibilidade a todos os antimicrobianos testados. Cronobacter spp. pode nمo representar risco à saْde dos indivíduos pelo consumo de queijos produzidos com leite pasteurizado. Entretanto, a presença de Cronobacter spp. em uma amostra de queijo demonstra falhas na produção, o que reforça a necessidade de maior adesão às Boas Práticas de Fabricação.

Cronobacter spp. is an opportunistic pathogen that may cause infections in individuals ofany age, and the highest incidence occurs in neonates, immunocompromised patients andelderly persons. This study investigated Cronobacter spp. occurrence in 90 cheese samples(30 “Minas Frescal” type cheeses, 30 “Prato” type and 30 sliced “Prato” type). The isolatedspecies were identified and the antimicrobial susceptibility profile of the isolated strains wasevaluated. The microbiological assay was performed with pre-enrichment in buffered peptonewater, and selective-enrichment in modified lauryl sulphate tryptose broth containingvancomycin. Isolation and identification were done in Enterobacter sakazakii Isolation Agar andin Vitek 2.0, respectively. The species identification was performed by multiple PCR targetingcgaA gene. Antibiogram was done using agar diffusion method (Kirby-Bauer). Cronobacter spp.was isolated from one (1.1 %) sample of “Minas Frescal” type cheese, identified as C. sakazakii which was sensitive to all of tested antimicrobials. Cronobacter spp. does not represent arisk to the individuals health by consuming cheeses made from pasteurized milk. However,the presence of Cronobacter spp. in one sample of analyzed cheese indicates failures in their production, reinforcing the need for following the Good Manufacturing Practices.

Pesquisa, identificação e perfil de suscetibilidade antimicrobiana de Cronobacter spp. em produtos destinados à alimentação infantil / Detection, identification and antimicrobial susceptibility profile of Cronobacter spp. in products for infant feeding

Cronobacter spp. emergiu como perigo microbiológico em fórmulas infantis desidratadas (FID), responsável por infecções graves em neonatos. Contudo, muitos pacientes não ingeriram FID, o que indica que outros alimentos podem atuar como veículo do patógeno. Os objetivos deste estudo foram pesquisar Cronobacter spp. em alimentos infantis, identificar as espécies e avaliar o perfil de suscetibilidade aos antimicrobianos das cepas isoladas. Foram analisadas 47 amostras pré-cozidas de cereais à base de grãos, amidos de milho e farinhas lácteas. A pesquisa foi realizada com pré-enriquecimento em água peptonada tamponada, enriquecimento seletivo no Cronobacter Screening Broth, isolamento por meio de Enterobacter sakazakii Isolation Agar e identificação no Vitek 2.0. A identificação das espécies foi realizada por reação em cadeia pela polimerase com alvo nos genes rpoB e cgcA. O antibiograma foi realizado pelo método de difusão em ágar (Kirby-Bauer). Cronobacter spp. foi identificada em 11 amostras (23,4 %). Oito cepas foram identificadas como C. sakazakii (72,7 %), duas como C. malonaticus (18,2 %) e uma como C. dublinensis (9,1 %). Apenas uma cepa de C. malonaticus apresentou resistência intermediária a ciprofloxacina. Os produtos destinados à alimentação infantil avaliados podem apresentar risco, no caso destes alimentos serem ingeridos por pacientes pertencentes ao grupo de risco, como neonatos e idosos.

Cronobacter spp. emerged as a microbiological hazard in powdered infant formulas (PIF)causing severe infections in newborns. However, among these patients many of them had not ingested PIF indicating that other foods categories might be as the pathogen vehicle. This study aimed at investigating Cronobacter spp. in infant foods, identifying the species and evaluatingthe antimicrobial susceptibility profile of the isolated strains. Forty-seven samples of precooked grain-based cereals, corn starch and milk flours were analyzed. The microbiological analysis was performed with pre-enrichment in buffered peptone water, followed by selective-enrichment in Cronobacter Screening Broth, isolation in Enterobacter sakazakii Isolation Agar and identificationin Vitek 2.0. The identification of species was performed by polymerase chain reaction targetingrpoB and cgaA genes. The antibiogram was carried out using the agar diffusion method(Kirby-Bauer). Cronobacter spp. was identified in 11 samples (23.4 %). Eight strains wereidentified as C. sakazakii (72.7 %), two as C. malonaticus (18.2 %) and one as C. dublinensis (9.1 %). Only one C. malonaticus strain showed an intermediate resistance to ciprofloxacin. The evaluated samples produced for infant feeding might cause hazard when ingested by patients belonging tothe risk group as newborns and elderly.

The Survey of Cronobacter spp. (formerly Enterbacter sakazakii) in Infant and Follow-up Powdered Formula in China in 2012 / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To determine Cronobacter spp. contamination in infant and follow-up powdered formula in China.</p><p><b>METHODS</b>All of 2282 samples were collected from the retail markets in China from January 2012 to December 2012, and analyzed for Cronobacter spp. by the Chinese National Food Safety Standard. Characterization of the isolates was analyzed by pulsed-field gel electrophoresis (PFGE) with XbaI and SpeI restriction enzymes.</p><p><b>RESULTS</b>Cronobacter spp. strains were isolated from 25 samples, and the positive rates in infant powdered formulas and follow-up powdered formulas were 0.90% (10/1011) and 1.18% (15/1271), respectively. Analysis of variable data regarding different purchasing store formats, seasonality, and production locations as well as comparison of infant versus follow-up formulas did not reveal statistically significant factors. During the sampling period, one of six surveillance zones did exhibit a statistically significant trend towards higher positive rate. PFGE characterization of Cronobacter spp. to elucidate genetic diversity revealed only three pairs of Cronobacter spp. out of 25 having the same PFGE patterns.</p><p><b>CONCLUSION</b>The current investigation indicated a lower positive rate of Cronobacter spp. in the powdered formula in China. This evidence suggested contamination originating from multiple different sources during the manufacturing process.</p>

Pesquisa, identificação e perfil de suscetibilidade antimicrobiana de Cronobacter spp. em produtos destinados à alimentação infantil / Detection, identification and antimicrobial susceptibility profile of Cronobacter spp. in products for infant feeding

Cronobacter spp. emergiu como perigo microbiológico em fórmulas infantis desidratadas (FID), responsável por infecções graves em neonatos. Contudo, muitos pacientes não ingeriram FID, o que indica que outros alimentos podem atuar como veículo do patógeno. Os objetivos deste estudo foram pesquisar Cronobacter spp. em alimentos infantis, identificar as espécies e avaliar o perfil de suscetibilidade aos antimicrobianos das cepas isoladas. Foram analisadas 47 amostras pré-cozidas de cereais à base de grãos, amidos de milho e farinhas lácteas. A pesquisa foi realizada com pré-enriquecimento em água peptonada tamponada, enriquecimento seletivo no Cronobacter Screening Broth, isolamento por meio de Enterobacter sakazakii Isolation Agar e identificação no Vitek 2.0. A identificação das espécies foi realizada por reação em cadeia pela polimerase com alvo nos genes rpoB e cgcA. O antibiograma foi realizado pelo método de difusão em ágar (Kirby-Bauer). Cronobacter spp. foi identificada em 11 amostras (23,4 %). Oito cepas foram identificadas como C. sakazakii (72,7 %), duas como C. malonaticus (18,2 %) e uma como C. dublinensis (9,1 %). Apenas uma cepa de C. malonaticus apresentou resistência intermediária a ciprofloxacina. Os produtos destinados à alimentação infantil avaliados podem apresentar risco, no caso destes alimentos serem ingeridos por pacientes pertencentes ao grupo de risco, como neonatos e idosos.

Cronobacter spp. emerged as a microbiological hazard in powdered infant formulas (PIF) causing severe infections in newborns. However, among these patients many of them had not ingested PIF indicating that other foods categories might be as the pathogen vehicle. This study aimed at investigating Cronobacter spp. in infant foods, identifying the species and evaluating the antimicrobial susceptibility profile of the isolated strains. Forty-seven samples of precooked grain-based cereals, corn starch and milk flours were analyzed. The microbiological analysis was performed with pre-enrichment in buffered peptone water, followed by selective-enrichment in Cronobacter Screening Broth, isolation in Enterobacter sakazakii Isolation Agar and identification in Vitek 2.0. The identification of species was performed by polymerase chain reaction targeting rpoB and cgaA genes. The antibiogram was carried out using the agar diffusion method (Kirby-Bauer). Cronobacter spp. was identified in 11 samples (23.4 %). Eight strains were identified as C. sakazakii (72.7 %), two as C. malonaticus (18.2 %) and one as C. dublinensis (9.1 %). Only one C. malonaticus strain showed an intermediate resistance to ciprofloxacin. The evaluated samples produced for infant feeding might cause hazard when ingested by patients belonging to the risk group as newborns and elderly.

Identificação de Cronobacter spp. em queijos e perfil de suscetibilidade antimicrobiana / Identification of Cronobacter spp. in cheeses and the antimicrobial susceptibility profile

Cronobacter spp. é um patógeno oportunista que pode causar infecções em indivíduos de qualquer idade, cuja incidência é maior em neonatos, pacientes imunocomprometidos e idosos. Neste estudo Cronobacter spp. foi pesquisado em 90 amostras de queijos (30 do tipo Minas Frescal, 30 do tipo Prato e 30 do tipo Prato fatiado). As espécies isoladas foram identificadas, e foi avaliado o perfil de suscetibilidade a antimicrobianos. A pesquisa foi realizada utilizando-se pré-enriquecimento em água peptonada tamponada, enriquecimento seletivo no caldo lauril sulfato triptose contendo vancomicina, isolamento no meio Enterobacter sakazakii Isolation Agar e identificação no Vitek 2.0. As espécies foram identificadas por meio de múltipla PCR com alvo no gene cgcA. O antibiograma foi realizado pela técnica de difusão em ágar (KirbyBauer). Cronobacter spp. foi isolada em uma (1,1 %) amostra de queijo tipo Minas Frescal, identificada como C. sakazakii que apresentou sensibilidade a todos os antimicrobianos testados. Cronobacter spp. pode não representar risco à saúde dos indivíduos pelo consumo de queijos produzidos com leite pasteurizado. Entretanto, a presença de Cronobacter spp. em uma amostra de queijo demonstra falhas na produção, o que reforça a necessidade de maior adesão às Boas Práticas de Fabricação.

Cronobacter spp. is an opportunistic pathogen that may cause infections in individuals of any age, and the highest incidence occurs in neonates, immunocompromised patients and elderly persons. This study investigated Cronobacter spp. occurrence in 90 cheese samples (30 “Minas Frescal” type cheeses, 30 “Prato” type and 30 sliced “Prato” type). The isolated species were identified and the antimicrobial susceptibility profile of the isolated strains was evaluated. The microbiological assay was performed with pre-enrichment in buffered peptone water, and selective-enrichment in modified lauryl sulphate tryptose broth containing vancomycin. Isolation and identification were done in Enterobacter sakazakii Isolation Agar and in Vitek 2.0, respectively. The species identification was performed by multiple PCR targeting cgaA gene. Antibiogram was done using agar diffusion method (Kirby-Bauer). Cronobacter spp. was isolated from one (1.1 %) sample of “Minas Frescal” type cheese, identified as C. sakazakii which was sensitive to all of tested antimicrobials. Cronobacter spp. does not represent a risk to the individuals health by consuming cheeses made from pasteurized milk. However, the presence of Cronobacter spp. in one sample of analyzed cheese indicates failures in their production, reinforcing the need for following the Good Manufacturing Practices.

Riesgo de contaminación por Cronobacter Sakazakii en leches en polvo para la nutrición de lactantes / Risk of Cronobacter Sakazakii contamination in powdered milk for infant nutrition

Introduction: Cronobacter spp. is a bacterial genus that includes 7 species; Cronobacter sakazakii is the clinical specie that is the most reported and associated with meningitis and septicemia in infants. Given that it is transmitted by powdered infant formula (PIF), the WHO recommends that this product be free of Cronobacter, whereas the Chilean Food Sanitary Regulation (RSA) does not consider it. Objective: To assess the risk of C. sakazakii in PIF for consumption by infants. Methodology: A total of 72 PIF samples were analyzed using three brands originating from three countries. Aerobic plate count (APC), Enterobacteriaceae (ENT), and most probable number (MPN) were performed using the methodology described by Puch and Ito (2001). Cronobacter differential agar was used to isolate strains (DFI, Oxoid, England), and the ID32E biochemical kit (Biomeriux, France) was used for phenotyping. The pathogen was identified and genotyped by multilocus sequence typing (MLST) based on the criteria found at http://www.pubmlst.org/cronobacter. Results: Median APC for step 1 and preterm PIF was 300 CFU/g (10-36 000) and 650 CFU (70-30 000), respectively and was higher in Chilean PIF (p=0.016). There were no significant differences for type, country or PIF brand in 75 CFU/g (10-36 000) and 200 CFU/g (10-1 000) ETN (p>0.05). Two strains from two different lots with characteristic strains in DFI agar were identified as C. sakazakii with 0.23 and 2.3 MPN/g. In addition, Franconibacter helveticus, specie closely related to Cronobacter spp, was found in two other strains. Conclusions: The prevalence of Cronobacter sakazakii in all the samples was 2.7% isolated only in PIFs manufactured in Chile. The absence of Cronobacter spp in 25 g must be included in the Chilean RSA.

Introducción: Cronobacter spp es un género bacteriano con 7 especies, siendo C. sakazakii la especie clínica más reportada y asociada a meningitis y septicemia en lactantes. Es transmitida por leche en polvo (LP) por lo que la OMS recomienda su ausencia en este producto. En Chile, el reglamento sanitario de los alimentos (RSA) no lo considera. Objetivo: Evaluar el riesgo por Cronobacter sakazakii en LP destinadas al consumo de lactantes. Metodología: Se analizaron 72 muestras de LP de 3 marcas y 3 países. El recuento de bacterias mesófilas (RAM), Enterobacteriaceae (ENT) y número más probable (NMP) se realizó con la metodología de Puch and Ito (2001). Se utilizó agar diferencial Cronobacter para aislamiento (DFI, Oxoid, England) y kit bioquímico ID32E (Biomeriux, Francia) para fenotipo. El patógeno fue identificado y genotipificado por multilocus sequence typing (MLST) utilizando criterios de http://www.pubmlst.org/cronobacter. Resultados: La medianas de RAM para LP etapa 1 y prematuros fueron 300 UFC/g (10-36 000) y 650 UFC/g (70-30 000), siendo mayor en las muestras de Chile (p=0,016). Para ENT de 75 UFC/g (10-1 060) y 200 UFC/g (30-1 000), no existiendo diferencias significativas por tipo, país o marca de LP (p>0,05). Dos cepas de 2 lotes diferentes características en agar DFI se identificaron como C. sakazaki con 0,23 y 2,3 NMP/g. Además de Franconibacter helveticus en otras 2 cepas, especie relacionada estrechamente con Cronobacter spp. Conclusiones: La prevalencia de C. sakazakii en todas las muestras fue de 2,7% y aisló sólo en LP de elaborados en Chile. La ausencia de Cronobacter spp en 25 g debe ser incorporado en el RSA de Chile.

Pesquisa de Cronobacter spp. em fórmulas infantis desidratadas / Screening the dehydrated powdered infant formulae for Cronobacter spp

Cronobacter spp. é uma bactéria oportunista associada a surtos de infecção em neonatos e criançasem virtude de consumo de fórmulas infantis desidratadas (FID). Neste contexto, o setor reguladortem criado normas específicas para o controle destes agentes patogênicos nas fórmulas infantis. Nesteestudo foi pesquisada a ocorrência de Cronobacter spp. em 60 amostras de FID comercializadas no Riode Janeiro, Brasil. Foram analisadas 30 amostras de fórmulas infantis para lactantes (0-6 meses) e 30 defórmulas infantis de seguimento para lactantes (> 6 meses) seguindo-se a metodologia de cultivo descritano Bacteriological Analytical Manual Online–FDA (2012). A identificação das colônias característicasfoi realizada com uso de kits ID32E, API20E e do sistema Vitek 2.0; e pela reação da polimerase emcadeia (PCR) com alvo no gene gluA. Nenhuma amostra apresentou contaminação por Cronobacterspp. Concluiu-se que a ocorrência de Cronobacter spp. em FID parece ser baixa, o que indica que osprodutores estão cumprindo o disposto nas normas brasileiras vigentes de forma a evitar a contaminaçãodos produtos por este micro-organismo...

Stress tolerant virulent strains of Cronobacter sakazakii from food

BACKGROUND: Cronobacter sakazakii is considered as an emerging foodborne pathogen. The aim of this study was to isolate and characterize virulent strains of Cronobacter sakazakii from food samples of Bangladesh. RESULT: Six (6) Cronobacter sakazakii was isolated and identified from 54 food samples on the basis of biochemical characteristics, sugar fermentation, SDS-PAGE of whole cell protein, plasmid profile and PCR of Cronobacter spp. specific genes (esak, gluA, zpx, ompA, ERIC, BOX-AIR) and sequencing. These strains were found to have moderately high antibiotic resistance against common antibiotics and some are ESBL producer. Most of the C. sakazakii isolates were capable of producing biofilm (strong biofilm producer), extracellular protease and siderophores, curli expression, haemolysin, haemagglutinin, mannose resistant haemagglutinin, had high cell surface hydrophobicity, significant resistance to human serum, can tolerate high concentration of salt, bile and DNase production. Most of them produced enterotoxins of different molecular weight. The isolates pose significant serological cross-reactivity with other gram negative pathogens such as serotypes of Salmonella spp., Shigella boydii, Shigella sonnei, Shigella flexneri and Vibrio cholerae. They had significant tolerance to high temperature, low pH, dryness and osmotic stress. CONCLUSION: Special attention should be given in ensuring hygiene in production and post-processing to prevent contamination of food with such stress-tolerant virulent Cronobacter sakazakii.

Efecto de la temperatura de refrigeración y calentamiento de fórmulas lácteas Infantiles en el crecimiento de cronobacter sakazakii / Effect of temperature cooling and heating of powered infant formula on the growth of cronobacter sakazakii

Cronobacter sakazakii (C. sakazakii) es un microorganismo perteneciente a la familia Enterobacteriaceae asociado con patologías como meningitis y septicemia en recién nacidos. Las fórmulas lácteas infantiles (FLI) han sido reconocidas como el vehículo más importante de transmisión de C. sakazakii, por condiciones inadecuadas durante su producción o preparación. El objetivo de la presente investigación fue evaluar el efecto de la temperatura de refrigeración y el calentamiento de las FLI en el crecimiento de C. sakazakii. Las muestras de FLI reconstituidas se contaminaron con 102, 104 y 106 UFC/mL de C. sakazakii y se refrigeraron durante cuatro horas a 4°C, 6°C y 10°C, posterioriormente, se calentaron en baño hidrotérmico hasta 37°C. Las muestras fueron sembradas al tiempo “0” (postrefrigeración) y luego del calentamiento hasta 37°C en placas con agar cromogénico y se incubaron a 35°C por 24h. Para el análisis de los datos se utilizó la prueba de Wilcoxon. Según los datos obtenidos no hubo variación significativa en la población de C. sakazakii en las FLI luego de 4 horas en refrigeración a 4°C, 6°C y 10°C; sin embargo, al calentar las fórmulas hasta 37°C, hubo en todos los casos una reducción de un ciclo logarítmico en la población de C. sakazakii con un valor de p = 0.0056 y Z= 2.752. Se concluye que el calentamiento a 37°C post-refrigeracion de las muestras, disminuye la población de C. sakazakii en FLI (p<0,05)(AU)

Cronobacter sakazakii (C. sakazakii) is a microorganism belonging to the family Enterobacteriaceae associated with diseases such as meningitis and sepsis in newborns. The powdered infant formula (PIF) have been recognized as the most important vehicle of transmission of C. sakazakii, by inadequate conditions during production or during its preparation. The aim of this investigation was to assess the effect of the cooling temperature and the heating of PIF in the growth of C. sakazakii. For this, PIF reconstituted samples were contaminated with 102, 104 and 106 CFU / mL of C. sakazakii and refrigerated for four hours at 4 ° C, 6 ° C or 10 ° C after this hydrothermal bath heated to 37 ° C. Samples were cultured at time “0” (after- cooling) and then heating to 37 ° C in chromogenic agar plates and incubated at 35 ° C for 24h . For data analysis we used the Wilcoxon test. According to the data there was no significant variation in the population of C. sakazakii in PIF after 4 hours in the refrigerator at 4 ° C, 6°C and 10 ° C , however , by heating the formulas to 37 ° C , in all cases there was a reduction of one log cycle in population C. sakazakii with a value of p = 0.0056 and Z = 2.752 . We conclude that heating at 37°C post- cooling of the samples, decreases the population of C. sakazakii in FLI ( p < 0,05 )(AU)

Phenotypic profiles and detection of target genes by PCR in isolates from different sources and reference strains, identified as Cronobacter spp. (Enterobacter sakazakii)

Cronobacter, formerly known as Enterobacter sakazakii, is a novel genus of the Enterobacteriaceae family recognized as a cause of high number of fatal cases in neonates, after consuming infant formula. The conventional methods for detecting these organisms are time-consuming and lack sensitivity. The ISO/TS 22964:2006 is the most recently standardized methodology for detecting Cronobacter in powderedinfant formula. This study aimed at confirming the Brazilian isolates previously identified as E. sakazakiias Cronobacter spp. by biochemical assays, and also to compare characteristics of 37 Cronobacter andnon-Cronobacter isolates; and the miniaturized kits and the ISO/TS methodology were evaluated. A conventional PCR protocol targeting dna G was also developed and a previously described gluA targeting protocol was used. The majority of the Brazilian isolates were not confirmed as Cronobacter spp., and the selective enrichment step of ISO/TS methodology was inhibitory to some Cronobacter strains. The ID 32 Ewas the most reliable kit. The PCR protocol targeting gluA showed consistent results with ID 32E and the developed dnaG PCR protocol was 100% sensitive and specific. Thus, the PCR protocols targeting gluA and dnaG might be used to complement the Cronobacter spp. detection or identification after performing the conventional isolation and identification methods.

Primer aislamiento de Cronobacter spp (Enterobacter sakazakii) en fórmula láctea en polvo producida en Chile / First isolation of Cronobacter spp (Enterobacter sakazakii) in powdered baby formula in Chile

La familia Enterobacteriaceae contempla agentes comunes en las enfermedades transmitidas por los alimentos. De esta familia Cronobacter spp, es considerado un patógeno que afecta principalmente a recién nacidos, los que pueden adquirirla a través de fórmulas lácteas infantiles en polvo contaminadas. Objetivo: Pesquisar Cronobacter spp, en una fórmula láctea en polvo producida en Chile. Material y método: En julio de 2008, se obtuvieron 80 muestras desde una planta ubicada en la Región de Los Lagos. Para el aislamiento de Cronobacter spp, se utilizó el método descrito en la norma ISO/TS 22964. Las muestras fueron analizadas en el Laboratorio de Alimentos del Instituto de Medicina Preventiva Veterinaria de la Universidad Austral de Chile. Resultados: Del total de muestras analizadas, el 5 por ciento (4 / 80) fueron confirmadas como Cronobacter spp, constituyendo así el primer reporte de esta bacteria en Chile. Conclusión: Cronobacter spp, está presente en una fórmula láctea en polvo producida en Chile. Su presencia en este producto representa un riesgo que no es considerado en el actual Reglamento Sanitario de los Alimentos de nuestro país.

The family Enterobacteriaceae includes agents that are commonly transmitted through food. Within this family, Cronobacter spp, is considered to be a pathogen that primarily affects newborns, which can acquire it through contaminated powdered formula. Objective: Isolate Cronobacter spp, in a powdered milk formula produced in Chile. Material and method: In July of 2008, 80 samples were obtained from a factory in the Los Lagos Region. To isolate Cronobacter spp, the methods described in the ISO/TS 22964 specifications were used. The samples were analyzed at the Food Laboratory at the Institute of Preventative Veterinary Medicine and the Universidad Austral de Chile. Results: Of all analyzed samples, 5 percent (4/80) were contaminated with Cronobacter spp, which constitutes the first report of this bacterium in Chile. Conclusion: Cronobacter spp is present in powdered baby formula produced in Chile. It’s presence in this product represents a risk that is not considered in the current food safety standards in this country.

Ocorrência de Cronobacter spp. (Enterobacter sakazakii) em alimentos infantis adquiridos em um hospital público / Occurrence of Cronobacter spp. (Enterobacter sakazakii) in infant food purchased in a public hospital

Cronobater spp. (E. sakazakii) é considerada um micro-organismo oportunista que vem ganhando atenção de autoridades de Saúde Pública, pelo crescente número de surtos de infecção em recém–nascidos e lactentes. A bactéria está associada a casos raros, com alta taxa de mortalidade, podendo causar meningites, enterocolite necrosante e septicemia. Cronobacter spp. tem ampla disseminação, porém apenas as fórmulas lácteas infantis em pó foram, epidemiologicamente, associadas às doenças causadas por esse agente. No presente estudo foi avaliada a ocorrência de Cronobacter spp. em alimentos destinados às crianças de 0-36 meses de idade, adquiridos em lactário de um hospital público do município de São Paulo. Vinte e seis amostras de fórmulas reconstituídas e 24 produtos em pó foram analisados segundo a metodologia da ISO. Cronobacter spp. foi detectada em uma amostra (3,8 por cento) reconstituída de alimento infantil à base de farinha de milho e em quatro desse produto em pó (16,7 por cento). A bactéria não foi detectada nas fórmulas infantis destinadas às crianças de 0-6 meses, contudo sua presença em outros alimentos infantis pode contribuir para a contaminação do ambiente e dos utensílios dos lactários por meio da contaminação cruzada.

Cronobacter sakazakii Infection Induced Fatal Clinical Sequels Including Meningitis in Neonatal ICR Mice / 한국실험동물학회지

Cronobacter sakazakii (C. sakazakii), formerly Enterobacter sakazakii, is an emerging pathogen associated with the ingestion of contaminated reconstituted formula that causes serious illnesses such as bacteremia, septicemia, necrotizing enterocolitis, meningitis and death in low-birth-weight preterm neonatal infants. The objective of this study was to develop an animal model for human neonatal C. sakazakii infections. We acquired timed-pregnant ICR mice and allowed them to give birth naturally. On postnatal day 3.5, each pup was administered orally a total dose of approximately 107 CFU C. sakazakii strain 3439. Mice were observed twice daily for morbidity and mortality. At postnatal day 10.5, the remaining pups were euthanized, and brain, liver, and cecum were excised and analyzed for the presence of C. sakazakii. C. sakazakii was isolated from cecum and other tissues in inoculated mice. In the tissues of C. sakazakii infected mice, meningitis and gliosis were detected in brain. In this study, we confirmed the neonatal ICR mice may be used a very effective animal model for human neonatal C. sakazakii infections.