Careful hygiene with powdered milk and breast pump equipment can help prevent dangerous bacterial infections, the CDC report warns


Cronobacter sakazakii, the bacterium that contaminated a large infant formula factory and caused a nationwide shortage, is a common natural pathogen. It is harmless to most people but can be life-threatening to infants, especially those born prematurely or with a compromised immune system.

Infections caused by the bacteria are rare, but a new report released Friday by the US Centers for Disease Control and Prevention highlights the importance of proper hygiene of breast pump equipment and safe storage and preparation of powdered infant formula out.

According to the U.S. Food and Drug Administration, Cronobacter sakazakii can enter homes and other spaces through hands, shoes, and other contaminated surfaces. It’s “particularly good at surviving in kibble.”

In one case described in the new CDC report, a 14-day-old infant was hospitalized in September 2021 with a fever, irritability, and excessive crying, along with a mouth infection and diaper rash. The genetic composition of the bacteria found in the infant’s cerebrospinal fluid matched very well with the bacteria found in an open can of powdered formula at home. A second strain of bacteria was also found on an open water container used to make the formula.

Most cases of Cronobacter infection are treatable with antibiotics, and this infant made a full recovery after 21 days of intravenous antibiotics.

However, it can lead to meningitis, sepsis, and other devastating complications like permanent brain damage. According to the CDC, about 40% of infants who develop meningitis die.

In one case from February 2022, an infant died two weeks after the onset of symptoms – despite treatment with antibiotics. This child was born prematurely and the symptoms included fever, slow heartbeat, difficulty breathing and seizures.

The bacteria matched samples from breast pump devices used at home, according to the CDC report. An interview revealed that the parts were cleaned, disinfected and sometimes assembled while still wet in a domestic sink. No bacteria were found in the milk samples, milk fortifier samples, hospital breast pump equipment, or unopened hospital milk powder solution.

“Due to the widespread occurrence of C. sakazakii in the environment, caregivers of infants should adhere to safe hygiene, preparation, and storage practices and learn steps to protect infants from infection,” the CDC report authors wrote. They encouraged healthcare providers to promote increased awareness of the risks and necessary precautions, particularly for those families with young children who are most at risk.

Cronobacter bacteria have been at the center of the nationwide infant formula shortage that began last year.

Several popular brands of powdered infant formula were recalled and production was halted at a major manufacturing facility after the U.S. Food and Drug Administration received reports of four infections, including two fatalities, in infants consuming Abbott Nutrition’s infant formula had. An FDA investigation found Cronobacter bacteria in the plant, but genetic testing hasn’t been able to link those bacteria to the sick infants.

According to Friday’s CDC report, most cases of Cronobacter sakazakii infection in infants “are not associated with outbreaks, but are likely to arise from isolated instances of contamination of household infant formula products and equipment.”

The CDC estimates that there are about 18 invasive infections in infants in the United States each year. However, it is not a nationally reportable disease, so the actual incidence is unknown.

However, in response to the events leading up to the infant formula shortage, the FDA presented a plan outlining proposed changes to improve monitoring of infant formula for the bacteria. Actions proposed by the FDA included an item to make Cronobacter sakazakii infection in infants a nationally reportable condition, which would require physicians to report cases to health authorities.

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