Invasive Cronobacter Infection in Infants

Reportable by Laboratories and Providers

About this Reportable Disease

Infectious agent: Cronobacter bacteria, most commonly Cronobacter sakazakii

Description of illness: Symptoms in infants <12 months old usually include fever, poor feeding, excessive crying, low energy, or seizures. Invasive infections can result in sepsis, meningitis, or other serious illness requiring hospitalization. Cronobacter bacteria are found in the environment and can contaminate breast pumps, powdered infant formula, or other dry surfaces.

Laboratory Reporting for this Disease

Cronobacter species

TEST NAME	Cronobacter species
DISEASE/DISORDER	Cronobacter infection
ALTERNATE NAME(S)	Cronobacter sakazakii, Enterobacter sakazakii, Cronobacter malonaticus, Enterobacter malonaticus
METHODOLOGY	Culture
SPECIAL INSTRUCTIONS	Isolate or specimen submission REQUIRED from infants (<12 months old) with invasive illness. Contact CEDEP if outbreak is suspected.
ORDERING INFORMATION	Lab Web Portal

Specimen Requirements

Patient Preparation	None
Specimen Collection	Acceptable Specimen Sources/Type(s) for Submission - Specimens from sterile and non-sterile sites - Isolates (preferred) - pure cultures
Specimen Labeling	Specimen should be labeled with at least two unique patient identifiers along with specimen source and match accompanying test order.
Specimen Processing	None
Specimen Storage and Preservation	Acceptable specimen types (sterile and non-sterile) should be stored at 2 - 8°C except for CSF, store at 15 - 25°C. Isolates on blood agar plates (BAP) should be stored in ambient conditions.
Specimen Transportation	Ship sterile or non-sterile specimens at 2 - 8°C except for CSF, ship at 15-25°C. Ship isolates at ambient conditions. All infectious substance shipments must conform to U.S. Department of Transportation (DOT) Hazardous Materials Regulations (HMR 49 C.F.R. Parts 171-180).
Specimen Acceptability and Rejection	Specimens that do not meet all specimen requirements will be rejected.
Testing Location	Nashville

Laboratory Reporting

Reporting requirements apply to all laboratories located within Tennessee, as well as laboratories outside of Tennessee that test residents of Tennessee, including laboratories located within healthcare facilities. Healthcare providers and laboratories in the same healthcare facility both have a duty to report. The type of organisms and analytes laboratories must report to TDH for 2026 are indicated, and there are several ways laboratories can report results to TDH.

Manually report results to TDH by faxing or mailing a completed PH-1600 form to your local health department, or faxing to the state health office at (615) 741-3857
Automatically submit results to TDH via electronic laboratory reporting (ELR), which automates the process of sharing data with TDH using interoperability standards.
- See the ELR Onboarding Handbook for details on the onboarding process, checklist, frequently asked questions, business rules, message format, and vocabulary.
- To initiate the ELR onboarding process with TDH, register in the Trading Partner Registration (TPR) system TPR provides documentation for Promoting Interoperability (PI) attestation and milestone letters to document onboarding progress. Contact MU.Health@tn.gov for assistance.
Submit online via NBS. NBS is TDH's reportable disease system. To request an NBS account for reporting Complete this user survey to request an NBS account for reporting.
Blood lead levels can be sent via fax ( (615) 741-3857), entered online, or reported using the instructions at this link.

Information about this Reportable Disease for Healthcare Providers

Clinical Summary

Invasive Cronobacter infection is a rare but life-threatening illness in infants (particularly in the first weeks of life) that commonly presents as sepsis and/or meningitis.
For infants with suspected sepsis or meningitis, CDC clinical care guidance supports hospitalization and full evaluation, including blood culture, urine culture, and CSF culture.
Start empiric antibiotics immediately when Cronobacter is suspected/diagnosed, and obtain antimicrobial susceptibility testing because multidrug-resistant strains have been reported.
CDC notes stool testing is not recommended for infant Cronobacter infection (it does not typically cause diarrhea in infants). If an infant has a culture-confirmed infection, clinicians/labs should coordinate with public health; CDC also notes formula testing is generally not recommended unless an infant has a diagnosed Cronobacter infection and testing is arranged via public health.
In Tennessee, Cronobacter infection (infants <12 months old) is a next-business-day reportable condition.

Clinical Links & Info

Disease Surveillance and Trends | CSTE

Review the case definition | CDC

Healthcare Provider Reporting

Healthcare reporting requirements apply to all providers located within Tennessee, as well as providers whose patients reside in Tennessee.

Providers must report cases of all diseases and conditions listed through one of these methods:

• Mail or fax a completed PH-1600 form to your local health department or fax to the state health office at (615) 741-3857

• Send automatically via electronic case reporting (eCR). See this TDH webpage for more information on eCR, register at the Trader Partner Registration website, or contact MU.Health@tn.gov for assistance.

• Submit online via NBS. NBS is TDH's reportable disease system. To request an NBS account for reporting Complete this user survey to request an NBS account for reporting.

• Blood lead levels can be sent via fax ( (615) 741-3857), entered online, or reported using the instructions at this link.

Information about this Reportable Disease for the Public

What It Is

Cronobacter are bacteria that can cause rare but serious infections. Newborns and young infants are at the highest risk for severe illness, including bloodstream infection (sepsis) and meningitis (infection of the lining around the brain and spinal cord).

Who Is at Highest Risk

Serious illness occurs most often in infants in the first days or weeks of life, particularly newborns and other vulnerable infants (for example, those born prematurely or with weakened immune systems).

Signs and Symptoms

In infants, illness can be hard to recognize early. Concerning signs can include fever, poor feeding, low energy (lethargy), excessive crying, or irritability, and severe infection may progress quickly. Meningitis can lead to serious, long-lasting neurologic problems.

How It Spreads

Cronobacter bacteria are found in the environment and can contaminate feeding items. Some infant infections have been linked to powdered infant formula, which is not sterile; contamination can happen in the product or after opening during preparation or handling.

Prevention for Families Using Infant Formula

Reducing risk focuses on safe feeding practices, especially for newborns and other high-risk infants. Steps include careful handwashing, cleaning/sanitizing bottles and parts, and following CDC guidance for powdered infant formula preparation and handling (including extra precautions for babies at highest risk).

This Page Last Updated: March 25, 2026 at 8:53 PM