Cronobacter Support
05-06-2009, 01:08 PM
1st International Conference on Cronobacter Poster Abstract 21
Current epidemiological aspects of Cronobacter infections
Cronobacter spp. (Enterobacter sakazakii) is a very rare cause of invasive neonatal infection. Public health relevance is attributed to the severe, complicated and often fatal course of neonatal Cronobacter-infections. The aim of this study was to elucidate current epidemiological information on Cronobacter-infections between 2000 and 2008 like lethality, sources of neonatal Cronobacter-infections other than contaminated infant formula and information about epidemiological reporting systems and food contaminations concerning Cronobacter spp. The data about neonatal Cronobacter-infections between 2000 and 2008 has been extracted from publications in scientific journals and from international (EWRS, FAO, RASFF, WHO) and national epidemiological reporting systems. Statistical analysis was carried out with SAS 9.1. Between 2000 and 2008, hundred and one cases of neonatal Cronobacter-infection have been reported. Detailed data have been available for sixty cases. The overall lethality of these neonatal Cronobacter-infections was 28.3%. The lethality of Cronobacter-meningitis, Cronobacter- bacteraemia / septicaemia and -necrotizing enterocolitis / hemorrhagic colitis) was calculated 76.5% (p<0.0001), 5.9% (p=0.33) and 23.5% (p<0.05), respectively. Univariate analysis of risk factors (gender, gestation age, birth weight, day of onset, region) revealed the minor gestation age (p<0.0001), minor birth weight (p=0.0002) and the European region (p<0.0001) as significant risk factor for letal outcome in neonatal Cronobacter-meningitis. In the bivariate linear regression model, the European region (p<0.0001) and minor gestation age (p<0.01) remain as significant risk factors for death in Cronobacter-meningitis. Nine cases of invasive Cronobacter-infections in neonates and infants, not fed with powdered infant formula, have been reported between 2000 and 2008. Among the five cases with detailed information, four are healthcare related infections. Neonatal Cronobacter-infection, based on clinical, epidemiological or microbiological criteria, should be reported, e.g. in Brazil, England and Wales, France, Hungary, Minnesota (USA), Northern Ireland, Norway, The Netherlands and New Zealand. In other countries, e.g. in Germany and Switzerland, (food-borne) related outbreaks are notifiable to local authorities. Between 2000 and 2008, the lethality of Cronobacter-meningitis in neonates has remained very high. Neonatal Cronobacter-infections are mainly associated with contaminated infant formula and the preparation equipment. Other sources for infection, e.g. the hospital environment should be considered in Cronobacter-infections. Neonatal Cronobacterinfections should be recorded in centralized (continental) reporting systems.
Miriam Friedemann
Federal Institute for Risk Assessment, Diedersdorfer Weg 1, Berlin, Germany.
Current epidemiological aspects of Cronobacter infections
Cronobacter spp. (Enterobacter sakazakii) is a very rare cause of invasive neonatal infection. Public health relevance is attributed to the severe, complicated and often fatal course of neonatal Cronobacter-infections. The aim of this study was to elucidate current epidemiological information on Cronobacter-infections between 2000 and 2008 like lethality, sources of neonatal Cronobacter-infections other than contaminated infant formula and information about epidemiological reporting systems and food contaminations concerning Cronobacter spp. The data about neonatal Cronobacter-infections between 2000 and 2008 has been extracted from publications in scientific journals and from international (EWRS, FAO, RASFF, WHO) and national epidemiological reporting systems. Statistical analysis was carried out with SAS 9.1. Between 2000 and 2008, hundred and one cases of neonatal Cronobacter-infection have been reported. Detailed data have been available for sixty cases. The overall lethality of these neonatal Cronobacter-infections was 28.3%. The lethality of Cronobacter-meningitis, Cronobacter- bacteraemia / septicaemia and -necrotizing enterocolitis / hemorrhagic colitis) was calculated 76.5% (p<0.0001), 5.9% (p=0.33) and 23.5% (p<0.05), respectively. Univariate analysis of risk factors (gender, gestation age, birth weight, day of onset, region) revealed the minor gestation age (p<0.0001), minor birth weight (p=0.0002) and the European region (p<0.0001) as significant risk factor for letal outcome in neonatal Cronobacter-meningitis. In the bivariate linear regression model, the European region (p<0.0001) and minor gestation age (p<0.01) remain as significant risk factors for death in Cronobacter-meningitis. Nine cases of invasive Cronobacter-infections in neonates and infants, not fed with powdered infant formula, have been reported between 2000 and 2008. Among the five cases with detailed information, four are healthcare related infections. Neonatal Cronobacter-infection, based on clinical, epidemiological or microbiological criteria, should be reported, e.g. in Brazil, England and Wales, France, Hungary, Minnesota (USA), Northern Ireland, Norway, The Netherlands and New Zealand. In other countries, e.g. in Germany and Switzerland, (food-borne) related outbreaks are notifiable to local authorities. Between 2000 and 2008, the lethality of Cronobacter-meningitis in neonates has remained very high. Neonatal Cronobacter-infections are mainly associated with contaminated infant formula and the preparation equipment. Other sources for infection, e.g. the hospital environment should be considered in Cronobacter-infections. Neonatal Cronobacterinfections should be recorded in centralized (continental) reporting systems.
Miriam Friedemann
Federal Institute for Risk Assessment, Diedersdorfer Weg 1, Berlin, Germany.