title: Genotypic and phenotypic analysis of Enterobacter sakazakii strains from an outbreak resulting in fatalities in a neonatal intensive care unit in France.
abstract: In 1994, an outbreak of Enterobacter sakazakii infections occurred in a neonatal intensive care unit in France from 5 May to 11 July. During the outbreak, 13 neonates were infected with E. sakazakii, resulting in 3 deaths. In addition, four symptomless neonates were colonized by E. sakazakii. The strains were subjected to 16S rRNA gene sequence analysis, genotyped using pulsed-field gel electrophoresis, and phenotyped for a range of enzyme activities. E. sakazakii was isolated from various anatomical sites, reconstituted formula, and an unopened can of powdered infant formula. A fourth neonate died from septic shock, attributed to E. sakazakii infection, during this period. However, 16S rRNA gene sequence analysis revealed that the organism was Enterobacter cloacae. There were three pulsotypes of E. sakazakii associated with infected neonates, and three neonates were infected by more than one genotype. One genotype matched isolates from unused prepared formula and unfinished formula. However, no pulsotypes matched the E. sakazakii strain recovered from an unopened can of powdered infant formula. One pulsotype was associated with the three fatal cases, and two of these isolates had extended-spectrum beta-lactamase activity. It is possible that E. sakazakii strains differ in their pathogenicities, as shown by the range of symptoms associated with each pulsotype.
authors.affiliation: School of Biomedical and Natural Sciences, Nottingham Trent University, Nottingham, UK.
authors.forename: J
authors.initials: J
authors.lastname: Caubilla-Barron
authors.forename: E
authors.initials: E
authors.lastname: Hurrell
authors.forename: S
authors.initials: S
authors.lastname: Townsend
authors.forename: P
authors.initials: P
authors.lastname: Cheetham
authors.forename: C
authors.initials: C
authors.lastname: Loc-Carrillo
authors.forename: O
authors.initials: O
authors.lastname: Fayet
authors.forename: M-F
authors.initials: MF
authors.lastname: Prère
authors.forename: S J
authors.initials: SJ
authors.lastname: Forsythe
mesh_terms: D015373:Bacterial Typing Techniques; D016000:Cluster Analysis; D044083:Cronobacter sakazakii / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D004275:DNA, Ribosomal / Q000737:chemistry / Q000235:genetics; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D005260:Female; D005602:France; D020459:Genes, rRNA; D005838:Genotype; D006801:Humans; D007223:Infant; D007225:Infant Food / Q000382:microbiology; D015931:Intensive Care, Neonatal; D008297:Male; D008969:Molecular Sequence Data; D010802:Phylogeny; D012329:RNA, Bacterial / Q000235:genetics; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D017422:Sequence Analysis, DNA; D012689:Sequence Homology, Nucleic Acid; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D004269:DNA, Bacterial; D004275:DNA, Ribosomal; D012329:RNA, Bacterial; D012336:RNA, Ribosomal, 16S; D001618:beta-Lactamases