Infection of Cronobacter sakazakii ST1 Producing SHV-12 in a Premature Infant Born from Triplet Pregnancy

Radosław Izdebski,Barbara Królak-Olejnik,Monika Lachowska,Paweł Urbanowicz,Dorota Żabicka

doi:10.3390/microorganisms9091878

Radosław Izdebski, Barbara Królak-Olejnik + Show 3 more

Open Access

https://doi.org/10.3390/microorganisms9091878

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Abstract

Cronobacter sakazakii can cause severe life-threatening invasive infections in neonates, with a high mortality rate mostly associated with powdered infant formula consumption. The study describes a fatal C. sakazakii infection in premature infant fed only with expressed human milk. Despite the identification of etiological factor from patient’s blood, the epidemiological investigation, including mother’s skin, hospital surfaces, milk expressing devices, and milk samples, did not show bacterial contamination. The infection was caused by C. sakazakii ST1, being one of the leading genotypes reported in invasive infections. The phylogenetic analysis of the international collection of the ST1 organisms allowed us to identify the isolate as a member of the main cluster. The pathogenic potential of the isolate was augmented by the presence of IncFIB-like molecule representing virulence plasmids of pESA-3 family. Isolate presented ESBL phenotype associated with blaSHV-12 gene harboured by IncX3 plasmid. The described case gave valuable information to genetics of Cronobacter, and also urges the need of wider whole-genome sequencing implementation as a part of diagnostic procedure.

Highlights

A large number of such reports concerned children consuming powder infant formula (PIF), in recent years some isolates have been identified in neonates fed exclusively with human milk [3,6,7]
The genotypes isolated from PIF, associated with neonatal septicaemia or meningitis cases, had been classified to a few groups of related organisms, of which ST4 and ST1 are the most common [2,8]
To the most important belong chromosomal genes involved in the biosynthesis of fimbriae, adhesion, and biofilm formation, and those localized on virulence plasmids of the pESA-3 family responsible for the synthesis and secretion of the siderophore, named Cronobactin [2]

Summary

Introduction

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The invasive infection in infants can be manifested as meningitis, necrotizing meningoencephalitis, septicemia, necrotizing entercolitis, cerebral infarctions, or brain abscesses [2]. These may progress rapidly, with death in a few hours from the first signs of infection, and a mortality rate 40–80% [1,3,4,5]. The genotypes isolated from PIF, associated with neonatal septicaemia or meningitis cases, had been classified to a few groups of related organisms, of which ST4 and ST1 are the most common [2,8]. Molecular studies of C. sakazakii genomes allowed us to define several virulence factors, which may play crucial roles in infections and enhance the pathogenicity of strains [2].

Case Presentation

Discussion