Contamination Of Powdered Infant Formula Research Articles

The risk of infectious pathogens in breast-feeding, donated human milk and breast milk substitutes.

This review collates the published reports that focus on microbial and viral illnesses that can be transmitted by breast milk, donor milk and powdered infant formula (PIF). In this context, we attempt to define a risk framework encompassing those hazards, exposure scenarios, vulnerability and protective factors. A literature search was performed for reported cases of morbidity and mortality associated with different infant feeding modes. Exclusive breast-feeding is the recommended for infant feeding under 6 months, or failing that, provision of donated human milk. However, the use of PIF remains high despite its intrinsic and extrinsic risk of microbial contamination, as well as the potential for adverse physiological effects, including infant gut dysbiosis. Viable pathogen transmission via breast-feeding or donor milk (pasteurised and unpasteurised) is rare. However, transmission of HIV and human T-cell lymphotropic virus-1 is a concern for breast-feeding mothers, particularly for mothers undertaking a mixed feeding mode (PIF and breast-feeding). In PIF, intrinsic and extrinsic microbial contamination, such as Cronobacter and Salmonella, remain significant identifiable causes of infant morbidity and mortality. Disease transmission through breast-feeding or donor human milk is rare, most likely owing to its complex intrinsically protective composition of human milk and protection of the infant gut lining. Contamination of PIF and the morbidity associated with this is likely underappreciated in terms of community risk. A better system of safe donor milk sharing that also establishes security of supply for non-hospitalised healthy infants in need of breast milk would reduce the reliance on PIF.

Food Safety and Invasive Cronobacter Infections during Early Infancy, 1961-2018.

Invasive Cronobacter infections among infants are associated with severe neurologic disabilities and death. Early Cronobacter reports typically featured hospitalized and preterm infants and recognized contaminated powdered infant formula (PIF) as a transmission vehicle. To clarify recent epidemiology, we reviewed all cases of bloodstream infection or meningitis among infants that were reported to the Centers for Disease Control and Prevention and in the literature (1961–2018; n = 183). Most infants were neonates (100/150 [67%]); 38% (42/112) died, and 79% (81/102) had reported recent PIF consumption. In the final quarter of the study period (2004–2018), case counts were significantly higher (global average 8.7 cases/year); among US cases, significantly higher proportions occurred among full-term (56% [27/48]) and nonhospitalized (78% [42/54]) infants. PIF contamination, most commonly from opened containers, was identified in 30% (21/71) of investigations. Our findings reaffirm the need to promote safer alternatives for infant feeding, particularly among neonates.

Detection and Molecular Characterization of <i>Cronobacter sakazakii</i> Isolated from Powdered Infant Formula (PIF) from North Central Region, Nigeria

Cronobacter sakazakii is an emerging ubiquitous and opportunistic pathogen that currently contaminates a wide spectrum of foods including powdered milk and poses a lethal threat to neonates, the elderly and persons with immune deficiencies. They cause life threatening neonatal meningitis, septicemia, and necrotizing enterocolitis. A total of 360 samples of powdered infant formula were collected from postnatal hospital attendees reconstituting the PIF for their children in the North Central region of Nigeria where cases of infant mortality are very high and presenting as enterocolitis and diarrhea. Pre-enriched samples were cultured in chromogenic Cronobacter broth and were then further sub-cultured into a chromogenic Cronobacter sakazakii agar. They were positive, exhibiting yellowish cultures typical of Cronobacter sakazakii. Biochemical tests of the isolates were also carried out and indicated the presence of Cronobacter sakazakii. The isolates were then characterized molecularly using specie specific PCR detection of Cronobacter sakazakii. The targeted genes of interest were ompA gene and CPA gene. The isolates tested showed bands for ompA gene on electrophoresis imager and were confirmed as Cronobacter sakazakii. In Nigeria, majority of infants are still fed with PIF. There is no existing data on the detection of Cronobacter sakazakii previously reported in the North central region of Nigeria hence the need to carry out the present study. The result of the study demonstrated the need for effective prevention and control measures as contamination of PIF with Cronobacter sakazakii constituted potential public health risk to neonates and infants.

Prevalence and Genetic Diversity of Cronobacter Species Isolated From Four Infant Formula Production Factories in China.

The aim of this study was to investigate the prevalence and genotypic characteristics of Cronobacter isolated from powdered infant formula (PIF) manufacturing facilities and to identify a potential source of contamination. A total of 42 Cronobacter isolates (5%) were detected in 835 environmental samples collected during the surveillance study. These isolates included C. sakazakii (n = 37), C. malonaticus (n = 3), and C. turicensis (n = 2). The isolates were divided into 14 sequence types (STs) by multi-locus sequence typing (MLST) and 21 pulsotypes (PTs) using pulsed-field gel electrophoresis (PFGE). The dominant C. sakazakii sequence types were ST3 (n = 12) and ST21 (n = 10), followed by ST136 (n = 6). The major PTs were PT22 (n = 12) and PT17 (n = 4) based on 100% similarity. Strains isolated from samples collected at the same production facility showed closer phylogenetic relation than those collected from distinct facilities. The result of extensive traceback sampling showed that PIF residues (PIF dust in production areas), fluid beds, drying areas, floors, and soil samples collected adjacent to the production facilities were the primary positive areas for Cronobacter. The present study outlines an effective approach to determine prevalence and genetic diversity of Cronobacter isolates associated with contamination of PIF.

Cronobacter Species Contamination of Powdered Infant Formula and the Implications for Neonatal Health.

Cronobacter is a class of Enterobacteriaceae that cause infections in neonates, especially those born prematurely. Over 90% of these infections have been linked epidemiologically to powdered infant formula (PIF). Contamination of PIF can occur at manufacture, reconstitution, or storage of reconstituted product. Intrinsic properties that enable Cronobacter to cause disease include resistance to heat, ultraviolet radiation, oxygen radicals, stomach acids, and pasteurization; an ability to utilize sialic acid (a nutrition additive to PIF that facilitates the organism’s growth and survival), and an exceptional affinity for biofilms in enteral feeding tubes. As part of ongoing endeavors to reduce the incidence of neonatal PIF-associated Cronobacter infections, the World Health Organization and the US Food and Drug Administration have established guidelines for PIF production, preparation for infant feeding, and storage of reconstituted product.

A Case of Cronobacter (Enterobacter sakazakii) Bacteremia in a Breastfed Infant.

Cronobacter multispecies complex (Cronobacter) is a member of the Enterobacteriaceae family that was described as a new genus in 2007 [ 1]. Consumption of contaminated powdered infant formula (PIF) has been associated with invasive Cronobacter infection in infants [ 1, 2]. The Food and Agricultural Organization and World Health Organization expert consultations in 2004 and 2006 concluded that Cronobacter contamination of PIF did cause infection and disease in infants [ 2]. Although the presence of Cronobacter in PIF is well documented, the nature of this organism may lead to exposure through other sources [ 1, 3]. Our case illustrates a rare example of Cronobacter bacteremia in an exclusively breastfed infant of a healthcare worker.

English

Morbidity and mortality of infant infections caused by contaminated powdered infant formula (PIF) have been reported worldwide, and pathogens like Enterobacter sakazakii andKlebsiella pneumoniae are important causative agents. To evaluate the prevalence of antibiotic resistance in E. sakazakii and K. pneumoniae that caused PIF contamination in Chinese market, all the isolates from PIF were analyzed for detecting resistance to antibiotics. 30 PIF samples were randomly purchased in Chinese market in 2009 and 7 E. sakazakii and 6 K. pneumoniae isolates were obtained from 8 samples (26.7%), the isolates were evaluated for antibiotics susceptibility by disk diffusion technique as recommended by the Clinical Laboratory Standards Institute (CLSI). Susceptibility results showed that each isolate had different levels of resistance to β-lactam antibiotics, while sensitive to fluoroquinolones and aminoglycosides. One K. pneumoniae and one E. sakazakii isolate almost resisted all Cephalosporins chosen; the double-disk synergy test (DDST) showed these two isolates producing extended spectrum β-lactamase (ESBL). This is the first report of ESBL-produing in E. sakazakii from powdered infant formula in China.   Key words: Klebsiella pneumonia, Enterobacter sakazakii, disk diffusion, antibiotic resistance, extended spectrum β-lactamase (ESBL).