Cronobacter Support
06-23-2009, 10:27 AM
2.1.2 Other relevant organisms of concern
Although liquid, ready-to-feed infant formula is commercially sterile, powdered infant formula is not. Enterobacteriaceae were present in 52 percent of 141 different formulas from 35 countries in one 1988 study (Muytjens, Roelofs-Willemse, and Jasper, 1988). Enterobacteriaceae are also common aetiologies for systemic infection in neonates and, to a lesser extent, older infants. E. sakazakii may be a sentinel organism, receiving attention due to its relative rarity. Other Enterobacteriaceae from powdered infant formula may also be responsible for systemic infections in infants, but there is little reported information to determine their role. One outbreak of Citrobacter freundii infections in a neonatal intensive care unit did identify formula as the vehicle of infection, though it was unclear if the formula was intrinsically (the source) or extrinsically contaminated.
Salmonella contamination of infant formula has been responsible for multiple outbreaks (Picket and Agate, 1967; Rowe et al., 1987; CDC, 1993; Usera et al., 1996; Threlfall et al., 1998; Olsen et al., 2001; Bornemann et al., 2002). Similar to E. sakazakii, low-level intrinsic contamination of powdered infant formula with Salmonella was epidemiologically and microbiologically associated with infections in infants in these outbreaks. Rates of salmonellosis are also highest in infants compared to any other age group (Olsen et al., 2001). The factors that give newborns a relatively high risk of infection include the relative gastric achlorhydria, the buffering capacity of the milk, the use of high iron infant formula and the need for frequent diaper changing (Miller and Pegues, 2000). Unlike E. sakazakii and other Enterobacteriaceae, however, Salmonella is rarely found in surveys of powdered infant formula. In the study surveying 141 different formulas by Muytjens, Roelofs-Willemse, and Jasper (1988), no samples yielded Salmonella.
Powdered infant formula has never been convincingly identified as a vehicle or source of infection for sporadic cases as opposed to outbreaks of infection with Salmonella, but this may well be due to the greater difficulty of identifying vehicles for sporadic infection. It would be illogical to conclude that sporadic infection due to powdered infant formula never occurred, but its frequency is unknown. Ongoing, large, sporadic case-control studies in the United States will be valuable in determining any potential association between significant numbers of sporadic salmonellosis cases and powdered infant formula.
Posted from ftp.fao.org/docrep/fao/007/y5502e/y5502e00.pdf
Although liquid, ready-to-feed infant formula is commercially sterile, powdered infant formula is not. Enterobacteriaceae were present in 52 percent of 141 different formulas from 35 countries in one 1988 study (Muytjens, Roelofs-Willemse, and Jasper, 1988). Enterobacteriaceae are also common aetiologies for systemic infection in neonates and, to a lesser extent, older infants. E. sakazakii may be a sentinel organism, receiving attention due to its relative rarity. Other Enterobacteriaceae from powdered infant formula may also be responsible for systemic infections in infants, but there is little reported information to determine their role. One outbreak of Citrobacter freundii infections in a neonatal intensive care unit did identify formula as the vehicle of infection, though it was unclear if the formula was intrinsically (the source) or extrinsically contaminated.
Salmonella contamination of infant formula has been responsible for multiple outbreaks (Picket and Agate, 1967; Rowe et al., 1987; CDC, 1993; Usera et al., 1996; Threlfall et al., 1998; Olsen et al., 2001; Bornemann et al., 2002). Similar to E. sakazakii, low-level intrinsic contamination of powdered infant formula with Salmonella was epidemiologically and microbiologically associated with infections in infants in these outbreaks. Rates of salmonellosis are also highest in infants compared to any other age group (Olsen et al., 2001). The factors that give newborns a relatively high risk of infection include the relative gastric achlorhydria, the buffering capacity of the milk, the use of high iron infant formula and the need for frequent diaper changing (Miller and Pegues, 2000). Unlike E. sakazakii and other Enterobacteriaceae, however, Salmonella is rarely found in surveys of powdered infant formula. In the study surveying 141 different formulas by Muytjens, Roelofs-Willemse, and Jasper (1988), no samples yielded Salmonella.
Powdered infant formula has never been convincingly identified as a vehicle or source of infection for sporadic cases as opposed to outbreaks of infection with Salmonella, but this may well be due to the greater difficulty of identifying vehicles for sporadic infection. It would be illogical to conclude that sporadic infection due to powdered infant formula never occurred, but its frequency is unknown. Ongoing, large, sporadic case-control studies in the United States will be valuable in determining any potential association between significant numbers of sporadic salmonellosis cases and powdered infant formula.
Posted from ftp.fao.org/docrep/fao/007/y5502e/y5502e00.pdf