Cronobacter Infection in Infants

Cronobacter sakazakii and related species — together, Cronobacter — are bacteria found naturally in the environment. They can live in dry foods such as powdered infant formula, powdered milk, herbal teas and starches, and have been found on contaminated feeding items such as breast pump equipment. Infections are rare, but in infants they can be deadly.

Signs and symptoms

In babies under 1 year old, Cronobacter infection usually begins with fever and poor feeding, excessive crying, or very low energy, and some babies have seizures. Take a baby with these symptoms to a medical provider as soon as possible.

The infection can cause:

• bloodstream infection (sepsis);
• meningitis, swelling of the membranes around the brain and spinal cord;
• urinary tract infection;
• infection of wounds such as cuts, scrapes or surgical sites.

Babies with meningitis can be left with serious, lasting brain problems.

Who is at risk

Anyone can be infected, but newborns face the greatest danger, usually in their first days or weeks. Those at highest risk are:

• infants under 2 months, the most likely to develop meningitis;
• premature infants;
• infants with weakened immune systems from illness or treatment such as cancer chemotherapy.

Older children and adults are infected less often. People 65 and older, and people with weakened immune systems — from drugs for cancer, other illnesses or organ transplants, HIV or genetic conditions — are more likely to get Cronobacter in their blood.

How it gets into formula

Infections in babies under 12 months are often linked to powdered infant formula, which is not sterile.

• At home, Cronobacter living on counters, in sinks or in water can get into formula after the container is opened — if lids or scoops are set on contaminated surfaces, or formula is mixed with contaminated water or in a contaminated bottle.
• In a factory, it can enter through contaminated ingredients or surfaces the powder touches during manufacturing.

Prevention

• Breastfeed if you can.
• Clean, sanitize and store infant feeding items safely.
• Keep hands and surfaces clean.
• Prepare and store formula safely.

How common is it?

Until 2024, invasive Cronobacter infection was not nationally notifiable, and only Minnesota and Michigan required reporting, so the true number of U.S. cases each year is unknown. Making infant infections notifiable should help. Cases in older children and adults still are not collected in routine surveillance.

• CDC typically receives 2–4 reports of severe infant infections a year and has had reports from 32 states; from January 2002 to July 2022 it received 76.
• About 20% of U.S. infants with Cronobacter meningitis or bloodstream infection have died, and worldwide about 40%.

Diagnosis and treatment

Cronobacter infection is diagnosed by laboratory testing of blood or cerebrospinal fluid. Antibiotics treat it, and infants with sepsis or meningitis should be hospitalized.

Sources

• Centers for Disease Control and Prevention: "About Cronobacter Infection." The page's stock photograph is not reproduced.