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Journal of Clinical Microbiology, January 2001, p. 293-297, Vol. 39, No. 1
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.1.293-297.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Outbreak of Necrotizing Enterocolitis Associated with Enterobacter sakazakii in Powdered Milk Formula

Jos van Acker,1 Francis de Smet,1,* Gaëtan Muyldermans,1 Adel Bougatef,2 Anne Naessens,1 and Sabine Lauwers1

Department of Microbiology1 and Neonatal Intensive Care Unit,2 Academisch Ziekenhuis Vrije Universiteit Brussel, Brussels, Belgium

Received 28 June 2000/Returned for modification 6 August 2000/Accepted 27 October 2000

We describe an outbreak of necrotizing enterocolitis (NEC) that occurred in the neonatal intensive care unit of our hospital. A total of 12 neonates developed NEC in June-July 1998. For two of them, twin brothers, the NEC turned out to be fatal. Enterobacter sakazakii, a known contaminant of powdered milk formula, was isolated from a stomach aspirate, anal swab, and/or blood sample for 6 of the 12 neonates. A review of feeding procedures revealed that 10 of the 12 patients were fed orally with the same brand of powdered milk formula. E. sakazakii was isolated from the implicated prepared formula milk as well as from several unopened cans of a single batch. Molecular typing by arbitrarily primed PCR (AP-PCR) confirmed, although partially, strain similarity between milk and patient isolates. No further cases of NEC were observed after the use of the contaminated milk formula was stopped. With this outbreak we show that intrinsic microbiological contamination of powdered milk formula can be a possible contributive factor in the development of NEC, a condition encountered almost exclusively in formula-fed premature infants. The use of sterilized liquid milk formula in neonatal care could prevent problems with intrinsic and extrinsic contamination of powdered milk formula.

* Corresponding author. Mailing address: Department of Microbiology, Academisch Ziekenhuis Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium. Phone: 32-2-4775000. Fax: 32-2-4775015. E-mail: labomicro{at}az.vub.ac.be.

Journal of Clinical Microbiology, January 2001, p. 293-297, Vol. 39, No. 1
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.1.293-297.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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