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Emergence of Cronobacter sakazakii in Cases of Neonatal Sepsis in Upper Egypt: First Report in North Africa
Amal A. Elkhawaga1, Helal F. Hetta1,2*, Naglaa S. Osman3, Amal Hosni4 and Mohamed A. El-Mokhtar1*
1Department of Medical Microbiology and Immunol

Research Authors
Amal A. Elkhawaga
Helal F. Hetta
Naglaa S. Osman
Amal Hosni
Mohamed A. El-Mokhtar
Research Journal
frontiers in Microbiology
Research Publisher
Frontiers Media S.A.
Research Rank
1
Research Vol
March 2020 | Volume 11 | Article 215
Research Website
https://doi.org/10.3389/FMICB.2020.00215
Research Year
2020
Research_Pages
9
Research Abstract

Background and Aim: Cronobacter sakazakii (C. sakazakii) has attracted considerable attention as an emerging neonatal pathogen and has been associated with outbreaks of life-threatening septicemia, necrotizing enterocolitis, and meningitis in neonates and infants globally. No data about the role of C. sakazakii as a cause of neonatal sepsis in North Africa is availale. Herein, we aimed to study the incidence of C. sakazakii in cases of neonatal sepsis, its distribution in different food samples in Egypt, antimicrobial profile, and the ability of the strains to form biofilms.

Methods: A total of 100 positive blood cultures from cases of neonatal sepsis admitted to the neonatal ICU at Assiut University Children’s Hospital, Egypt, were analyzed. In addition, 1,100 food samples, including 400 powdered infant formula (PIF), 500 herbs, and 200 water samples were screened for the presence of C. sakazakii. We evaluated the antimicrobial profile and the ability of the strains to form biofilms.
Results:Cronobactersakazakii wasdetectedin12outof100casesofneonatalsepsis. The organism was also isolated from PIF, herbs, and water in percentages of 17.5, 9.2, and 7.5%, respectively. Regarding the antimicrobial sensitivity, all strains were resistanttoampicillin,amoxicillin,ampicillin/sulbactam,clindamycin,cephalothin,andcephalexin. In addition, C. sakazakii strains showed the ability to form biofilms, but with variable degrees of cell density.

Conclusion: We reported, for the first time, cases of neonatal sepsis caused by the emerging life-threatening pathogen C. sakazakii in Egypt. The organism was also detected in contaminated PIF, herbs, and water, which may be sources of infection for neonates, especially in countries where natural herbs are widely used as an alternative medicine. Finally, collective efforts by the parents, manufacturers of PIF, and healthcare personnel are essential to prevent serious infections caused by C. sakazakii, particularly in infants.