Emergence of Cronobacter sakazakii in Cases of Neonatal Sepsis in Upper Egypt: First Report in North Africa.

Amal A Elkhawaga,Naglaa S Osman,Helal F Hetta,Mohamed A El-Mokhtar,Amal Hosni

doi:10.3389/fmicb.2020.00215

Amal A Elkhawaga, Naglaa S Osman + Show 3 more

Open Access

https://doi.org/10.3389/fmicb.2020.00215

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Abstract

Background and AimCronobacter sakazakii (C. sakazakii) has attracted considerable attention as an emerging neonatal pathogen and has been associated with outbreaks of life-threatening septicemia, necrotizing enterocolitis, and meningitis in neonates and infants globally. No data about the role of C. sakazakii as a cause of neonatal sepsis in North Africa is availale. Herein, we aimed to study the incidence of C. sakazakii in cases of neonatal sepsis, its distribution in different food samples in Egypt, antimicrobial profile, and the ability of the strains to form biofilms.MethodsA total of 100 positive blood cultures from cases of neonatal sepsis admitted to the neonatal ICU at Assiut University Children’s Hospital, Egypt, were analyzed. In addition, 1,100 food samples, including 400 powdered infant formula (PIF), 500 herbs, and 200 water samples were screened for the presence of C. sakazakii. We evaluated the antimicrobial profile and the ability of the strains to form biofilms.ResultsCronobacter sakazakii was detected in 12 out of 100 cases of neonatal sepsis. The organism was also isolated from PIF, herbs, and water in percentages of 17.5, 9.2, and 7.5%, respectively. Regarding the antimicrobial sensitivity, all strains were resistant to ampicillin, amoxicillin, ampicillin/sulbactam, clindamycin, cephalothin, and cephalexin. In addition, C. sakazakii strains showed the ability to form biofilms, but with variable degrees of cell density.ConclusionWe reported, for the first time, cases of neonatal sepsis caused by the emerging life-threatening pathogen C. sakazakii in Egypt. The organism was also detected in contaminated PIF, herbs, and water, which may be sources of infection for neonates, especially in countries where natural herbs are widely used as an alternative medicine. Finally, collective efforts by the parents, manufacturers of PIF, and healthcare personnel are essential to prevent serious infections caused by C. sakazakii, particularly in infants.

Highlights

The Cronobacter genus is a member of the family Enterobacteriaceae that includes seven species, of which Cronobacter sakazakii is the main species linked to lifethreatening infections in infants and immunocompromised adults (Feeney et al, 2014)
We reported, for the first time, cases of neonatal sepsis caused by the emerging life-threatening pathogen C. sakazakii in Egypt
The organism was detected in contaminated powdered infant formula (PIF), herbs, and water, which may be sources of infection for neonates, especially in countries where natural herbs are widely used as an alternative medicine

Summary

Introduction

The Cronobacter genus is a member of the family Enterobacteriaceae that includes seven species, of which Cronobacter sakazakii is the main species linked to lifethreatening infections in infants and immunocompromised adults (Feeney et al, 2014). It is a Gram-negative, motile, nonspore-forming, facultative anaerobe. We aimed to study the incidence of C. sakazakii in cases of neonatal sepsis, its distribution in different food samples in Egypt, antimicrobial profile, and the ability of the strains to form biofilms

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