Desiccation resistance and persistence of Cronobacter species in infant formula

Cronobacter is a newly described genus which includes opportunistic pathogens formerly known as ‘Enterobacter sakazakii’. These organisms have been isolated from a wide variety of sources, including powdered infant formula (PIF). This review focuses on the desiccation survival of Cronobacter, and its relevance to vehicles of infection. Due to its probable natural habitat of plant material, the organism has an array of survival mechanisms which includes resistance to desiccation and osmotic stresses. The organism can survive for long periods of time (> 2 years) in the desiccated state, and can be recovered from a large number of powdered foods in addition to powdered infant formula. On reconstitution, the organism may rapidly multiply and present a risk to immunocompromised infants. It is expected that an improved understanding of the nature of Cronobacter persistence may aid in further improved control measures and eliminate the bacterium from the critical food production environments

Effect of desiccation, starvation, heat, and cold stresses on the thermal resistance of Enterobacter sakazakii in rehydrated infant milk formula

Enterobacter sakazakii has been implicated in outbreaks of meningitis, septicemia, and necrotizing enterocolitis in immunocompromised and premature neonates. In this study, the effect of desiccation stress, starvation stress, heat shock and cold shock on thermal inactivation of E. sakazakii in rehydrated infant milk formula was evaluated. Stressed cells were mixed with rehydrated infant milk formula at 52, 54, 56, and 58°C for various time periods. The D- and z-values were determined by using linear regression analysis. Z)-values for unstressed E. sakazakii at 52, 54, 56 and 58°C were 15.33, 4.53, 2.00 and 0.53 min, respectively. Desiccation and heat stress, but not starvation or cold stress, caused significant reduction in Z)-values. For example, D52 was 15.33 min for unstressed cells compared with 8.72 and 7.36 after desiccation and heat stress. Z-values of 53 desiccated, starved, heat shocked and cold shocked E. sakazakii were not significantly different from unstressed cells (4.22°C). The results of this study may be of use to regulatory agencies, infant milk producers and infant caregivers to design heating processes to eliminate E. sakazakii that may be present in infant milk formula

Detergent and sanitizer stresses decrease the thermal resistance of Enterobacter sakazakii in infant milk formula

Infant milk formula has been identified as a potential source of Enterobacter sakazakii. This bacterium can cause a severe form of neonatal meningitis and necrotizing entercolitis. This study determined the effect of acid, alkaline, chlorine and ethanol stresses on the thermal inactivation of E. sakazakii in infant milk formula. Stressed cells were mixed with reconstituted powdered infant milk formula (PIMF) at temperatures between 52 and 58°C for various time periods or mixed with PFMF prior to reconstitution with water at temperatures between 50 and 100°C. The D- and z-values of the cells were determined using linear regression analysis. Detergent and sanitizer stresses decreased the thermal resistance of E. sakazakii in powdered and reconstituted infant milk formula. The values for Z)- acid, alkaline, chlorine and ethanol stressed E. sakazakii at 52-58°C were 14.57-0.54, 12.07-0.37, 10.08-0.40 and 11.61-0.50 min, respectively. The values of alkaline, chlorine and ethanol stressed cells were significantly lower than those of unstressed cells. Only the z-value (4.4°C) of ethanol stressed E. sakazakii was significantly different than that of unstressed cells (4.12°C). Reconstitution at 60°C did not significantly reduce the number of pre-stressed E. sakazakii cells compared with unstressed control cells, whereas significant decreases were obtained at 70°C. Using water at 70°C during the preparation of reconstituted PIMF before feeding infants, may be a suitable and applicable means of reducing the risk of E. sakazakii in the formula. The results of this study may be of use to regulatory agencies, infant milk producers and infant caregivers to design heating processes to eliminate E. sakazakii that may be present in infant milk formula

International survey of Cronobacter sakazakii and other Cronobacter spp. in follow up formulas and infant food

A coordinated survey for Cronobacter and related organisms in powdered infant formula, follow up formula and infant foods was undertaken by 8 laboratories in 7 countries in recognition of and in response to the data needs identified in an FAO/WHO call for data in order to develop global risk management guidance for these products. The products (domestic and imported) were purchased from the local market and were categorised according to their principle ingredients. A total of 290 products were analysed using a standardised procedure of pre-enrichment in 225 ml Buffered Peptone Water (BPW), followed by enrichment in Enterobacteriaceae Enrichment (EE) broth, plating on the chromogenic Cronobacter Druggan–Forsythe–Iversen (DFI) agar and presumptive identification with ID 32 E. Presumptive Cronobacter isolates were identified using 16S rRNA gene sequence analysis. Aerobic plate counts (APC) of the products were also determined on nutrient agar. Fourteen samples had APC > 105 cfu/g, 3 of which contained probiotic cultures. C. sakazakii was isolated from 27 products; 3/91 (3%) follow up formulas (as defined by Codex Alimentarius Commission), and 24/199 (12%) infant foods and drinks. Hence C. sakazakii was less prevalent in follow up formula than other foods given to infants over the same age range. A range of other bacteria were also isolated from follow up formulas, including Acinetobacter baumannii, Enterobacter cloacae, Klebsiella pneumoniae, Citrobacter freundii, and Serratia ficaria. There was significant variation in the reconstitution instructions for follow up formulas. These included using water at temperatures which would enable bacterial growth. Additionally, the definition of follow up formula varied between countries

Survival and growth of Cronobacter species (Enterobacter) sakazakii in wheat-based infant follow on formulas

Aim: To determine the survival and growth characteristics of Cronobacter species (Enterobacter sakazakii) in infant wheat-based formulas reconstituted with water, milk, grape juice or apple juice during storage. Methods and Results: Infant wheat-based formulas were reconstituted with water, UHT milk, pasteurized grape or apple juices. The reconstituted formulas were inoculated with C. sakazakii and C. muytjensii and stored at 4, 25 or 37°C for up to 24h. At 25 and 37°C, Cronobacter grew more (>5 logio) in formulas reconstituted with water or milk than those prepared with grape or apple juices (ca. 2-3 logio). The organism persisted, but did not grow in any formulas stored at 4°C. Formulas reconstituted with water and milk decreased from pH 6.0 to 4.8-5.0 after 24h, whereas the pH of the formulas reconstituted with fruit juices remained at their initial pH values, ca. pH 4.8-5.0. Conclusion: C sakazakii and C muytjensii can grow in reconstituted wheat-based formulas. If not immediately consumed, these formulas should be stored at refrigeration temperatures to reduce the risk of infant infection. Significance and Impact of the Study: The results of this study will be of use to regulatory agencies and infant formula producers to recommend storage conditions that reduce the growth of Cronobacter in infant wheat-based formulas

Healthy food and determinants of food choice on online food delivery applications.

Online food delivery applications (OFD apps) provide consumers with a wide range of options to choose from. The present study aimed to assess the usage of OFD apps and investigate the factors that affect food choices with a special emphasis on healthy food choices and hygiene. A cross-sectional study among food delivery application users in Jordan was conducted using an online questionnaire between March and May 2022. A total of 675 eligible subjects participated in the study. Consumers' demographic characteristics, data on consumers' use of OFD apps, consumers' perceptions of healthy food availability in OFD apps, and consumers' attitudes toward food safety and delivery hygiene were collected and analyzed. About 64% of the studied sample used OFD apps weekly. Fast food was the most popular option for ordering (87.1%) and lunchtime was the most preferred time to order food (67.3%) for most of the respondents. Respondents' perceptions of a "healthy meal" was associated with the presence of a variety of vegetables in the meal. Food price, food appearance, time of delivery, macronutrient content information, the availability of healthy options, and considering vegetables as part of a healthy meal were determinants of consumer food choice (p<0.05). The findings suggest that the online food environment in Jordan was perceived to be unhealthy. Nevertheless, the convenient nature and the popularity of OFD apps hold great potential to promote healthy eating among consumers

The Cronobacter genus: ubiquity and diversity

Members of the Cronobacter genus (formerly Enterobacter sakazakii) have become associated with neonatal infections and in particular contaminated reconstituted infant formula. However this is only one perspective of the organism since the majority of infections are in the adult population, and the organism has been isolated from the enteral feeding tubes of neonates on non-formula diets. In recent years methods of detection from food and environmental sources have improved, though accurate identification has been problematic. The need for robust identification is essential in order to implement recent Codex Alimentarius Commission (2008) and related microbiological criteria for powdered infant formula (PIF; intended target age 0-6 months). Genomic analysis of emergent pathogens is of considerable advantage in both improving detection methods, and understanding the evolution of virulence. One ecosystem for Cronobacter is on plant material which may enable the organism to resist desiccation, adhere to surfaces, and resist some antimicrobial agents. These traits may also confer survival mechanisms of relevance in food manufacturing and also virulence mechanisms

Prevalence, antibiotic resistance and genotypes of Campylobacter jejuni and Campylobacter coli isolated from chickens in Irbid governorate, Jordan

Campylobacter is the world's leading cause of bacterial gastroenteritis, causing nearly 9 million cases of food poisoning in Europe every year. Poultry is considered the main source of Campylobacter infection to humans. The objectives of the study were to determine occurrence of C. jejuni and C. coli in chickens, the antimicrobial resistance, genotypes, and relatedness of the isolates. A total of 177 chicken samples obtained from informal butcher shops (fresh), formal poultry slaughterhouses (refrigerated) and retail market (frozen) were analyzed. Isolation of Campylobacter spp. was conducted according to the ISO 10272-2006 method. Multiplex PCR was used for confirmation and identification of the isolates. The disk diffusion method was used to determine the antimicrobial resistance of the isolates and multilocus sequence typing was used for genotyping. The proportion of samples with Campylobacter spp. was 31.6% among all chicken samples (fresh and refrigerated 47.5%, frozen 0%) C. coli was isolated from 42.4% of chicken samples obtained from butcher shops and from 18.6% of samples obtained in formal slaughterhouses. C. jejuni was isolated from 17.0% of samples obtained in butcher shops and formal slaughterhouses. Campylobacter spp. was not isolated in frozen chicken samples. All tested isolates showed resistance toward ciprofloxacin and susceptibility toward imipenem and all of the isolates were multidrug resistant toward 5 or more antimicrobials. Three sequence types were identified among 10 C. coli isolates and seven sequence types were identified among 10 C. jejuni isolates. Among sequence types, chicken isolates shared similarities of both phenotypic and genetic levels

An innovative state-of-the-art health storytelling technique for better management of type 2 diabetes

BackgroundType 2 diabetes (T2D) is a chronic lifelong disease that requires long-term prevention and management strategies in a community setting. A health story is a novel technique that may be used as an effective tool for better prevention and management of T2D.ObjectiveThe main objective of this study is to develop a story to be used as a social health technique based on contemporary scientific knowledge that may be used at a community level for better communication and management of T2D.MethodsA community–academic partnership was formed with a not-for-profit Nutrition Education, Awareness, and Training (NEAT) organization in Khyber Pakhtunkhwa, Pakistan. We agreed to develop a story that may be used as a health and nutrition education communication tool for better management of patients with T2D. The following phases were followed during the story creation process: (1) the theory phase, (2) the modeling phase, and (3) the evaluation phase. Raters evaluated the story to determine its literary and scientific quality, comprehensiveness, and T2D specificity.ResultsThe title of the story translated into English is “The Story of Diabetes—The Story of Success.” It is text based and contains 86 pages in the local language, “Pashto,” with an English translation. The story is divided into five chapters and describes the initial diagnosis, fear associated with the disease, issues related to referral to certified practitioners, the importance of a balanced diet, and related lifestyle habits. After story evaluation, the raters suggested its literary and scientific quality, comprehensiveness, and T2D specificity (Pearson correlation scores of &gt;0.8).ConclusionThis unique story was created for T2D and found to be of significant quality in terms of its literary and scientific quality, as well as its comprehensiveness and diabetes specificity. As a result, it may be suggested that it can be used in subsequent studies to improve T2D management among adult patients