Cronobacter Infection: How to Treat

Treatment options for Cronobacter infections include the following:

• Carbapenems or antipseudomonal penicillins (for example, mezlocillin, piperacillin, piperacillin/tazobactam, ticarcillin, and ticarcillin/clavulanate) are preferred, with ciprofloxacin as an option.
• Because of resistance to beta-lactams, cephalosporins, aminoglycosides, quinolones, and third-generation cephalosporins, care must be given when selecting an antibiotic. It is advised that the organism's medication resistance pattern be determined early on so that the infection can be adequately treated from the start.
• In rare cases, Cronobacter infection may cause brain abscesses. Because brain abscesses do not usually respond to antibiotic medication, surgery may be required to drain the abscess.
• Fluids and electrolytes must be administered to people with gastrointestinal issues.
• Studies have reported that with the emergence of multidrug resistance and antibiotic side effects, plant products can act as effective antimicrobial agents against Cronobacter sakazakii. Lactic acid bacteria can aid in the management of C. sakazakii infections. Certain probiotics may be beneficial for healthy gut colonization and barrier function in the battle against pathogen adhesion.

If an infant develops Cronobacter-related sepsis or meningitis, they must be admitted to the hospital immediately. Doctors will administer medications such as intravenous antibiotic treatment. 

Antibiotics are administered to adults who have a urinary tract infection or Cronobacter-related wound infections. However, if bacteria are present but not causing symptoms, therapy may not be required.

Cronobacter sakazakii (previously Enterobacter sakazakii) is a bacterium that can thrive in extremely dry environments. 

It can be found in dehydrated goods such as infant formula, protein shakes, and powdered milk, as well as ordinary pantry items such as herbal teas and starches such as potatoes and rice. 

It is also found in sewage water. Cronobacter spp. or (E. sakazakii) is a gram-negative, motile, rod-shaped, non-spore-forming bacterium that can thrive in both aerobic and anaerobic settings. It is classified as an opportunistic pathogen.

Cronobacter infection is rare, with 2-4 cases reported to the CDC each year.

Infants

Initial symptoms of Cronobacter infection in babies typically include:

• Fever
• Poor feeding
• Crying or extremely low energy

You should take a newborn to the doctor if they exhibit these symptoms:

• Uncontrolled crying
• Poor feeding
• Very low energy
• Jaundice
• Grunting while breathing
• Unstable body temperature
• Stomach pain, vomiting, and diarrhea
• Blood in stools or a swollen abdomen
• Changes in mood (irritated or overly sleepy compared to baseline)

Cronobacter infections are uncommon, but they can be fatal in newborns. Infections can cause brain inflammation, blood poisoning, or gut infection. 

A Cronobacter sakazakii infection can potentially cause meningitis, an inflammation of the membranes around the brain and spinal cord.

Meningitis symptoms due to C. sakazakii infection in infants include:

• High fever
• Constant crying
• Excessive sleepiness or irritability
• Sluggishness
• Poor feeding
• A bulge in the soft spot on the top of the head
• Stiffness of the body and neck
• Seizures

Adults

In adults, symptoms of a cronobacter infection vary from person to person. However, it generally causes the following:

• Diarrhea
• Urinary tract infections
• Poor wound healing in areas of skin scrapes or at surgical incision sites
• Sepsis in people who are 65 years or older or whose bodies cannot fight off infections

Bacteria may grow (or colonize) but not cause any symptoms in some people; in such cases, the bacteria are usually found in their stools

Although Cronobacter is naturally prevalent in the environment, researchers are unsure whether it can be transmitted from person to person.

Although uncommon, it is most likely to spread when people do not thoroughly wash their hands or the products they use.

The bacterium has been detected in newborn formula and, in rare cases, in infants. In some cases, the powder was contaminated during manufacturing, or it came into contact with a bacteria-infested region. 

However, germs can also enter the powder after opening it at home. This can occur if you place the formula scoop or lid on the counter or sink, and bacteria there comes into contact with the formula.

Cronobacter has the potential to cause life-threatening infections, especially in:

• Babies younger than 2 months
• Prematurely born children
• People aged 65 years and older
• Babies and adults with impaired immune systems as a result of diseases such as human immunodeficiency virus, organ transplantation, or cancer

Cronobacter sakazakii is typically diagnosed through blood samples, urine samples, or cerebrospinal fluid to check for traces of the bacteria.

For meningitis, brain imaging tests such as a magnetic resonance imaging scans are performed to see if the infection caused brain abscesses or infarctions.

In adults, Cronobacter may be found around open wounds or fecal matter.

The CDC recommends the following steps to prevent a Cronobacter infection:

Breastfeeding

Breastfeeding is one of the most beneficial things you can do for your child's health and development. Advantages include the prevention of several types of illnesses, such as ear and respiratory infections. There are few recorded occurrences of Cronobacter infections in breastfed newborns

Cleaning and sanitization

Feeding utensils, breast pump parts, and baby bottles should be cleaned, sanitized, and stored carefully.  You can help prevent contamination and keep milk safe by washing and disinfecting all feeding equipment carefully.

Liquid formula

If your infant needs formula, use liquid formula when possible. When handled properly, liquid baby formula is sterile and should not transmit Cronobacter infection. This is especially crucial if your infant is younger than 3 months, was born preterm, or has a weaker immune system. 

Powdered formula is not sterile. If you do have to use powdered formula, check to see that your formula hasn't expired or been recalled and that the container is in good shape. Clean powdered formula lids and scoops, and close formula containers as quickly as possible.

Other tips

If your infant is younger than 3 months, was born prematurely, or has a weaker immune system, you may want to take the extra precautions:

• Prepare infant formula with hot water (at least 158 F/70 C). Countertops and sinks should be kept clean.
• Instead of swirling the liquid, carefully shake the closed bottle with the precise amount of formula specified on the container.
• Before feeding your infant, cool the formula to body temperature to ensure it is not too hot.
• Place the prepared, capped bottle in a chilly water bath or in an ice bath. Allow no water to enter the bottle or touch the nipple.
• Before feeding the infant, test the temperature of the formula by dabbing a few drops on the inside of your wrist. It should feel warm rather than heated.
• Prepared infant formula should be used within 1 hour of starting the feeding and within 2 hours of being prepared. Throw away any remaining formula if your infant does not eat.
• If you do not plan to use the prepared formula right away, refrigerate it immediately. Use refrigerated formula within 24 hours. 
• If you can’t remember how long you have kept formula in the refrigerator, it is safer to throw it out than to feed it to your baby.
• Don’t feed your baby homemade baby formula without checking with your doctor first.