Environmental risk factors associated with the survival, persistence, and thermal tolerance of <i>Cronobacter sakazakii</i> during the manufacture of powdered infant formula

Abstract

<i>Cronobacter sakazakii</i> is an opportunistic foodborne pathogen of concern for foods having low water activity such as powdered infant formula (PIF). Its survival under desiccated stress can be attributed to its ability to adapt effectively to many different environmental stresses. Due to the high risk to neonates and its sporadic outbreaks in PIF, <i>C. sakazakii</i> received great attention among the scientific community, food industry and health care providers. There are many extrinsic and intrinsic factors that affect <i>C. sakazakii</i> survival in low-moisture foods. Moreover, short- or long-term pre-exposure to sub-lethal physiological stresses which are commonly encountered in food processing environments are reported to affect the thermal resistance of <i>C. sakazakii</i>. Additionally, acclimation to these stresses may render <i>C. sakazakii</i> resistance to antibiotics and other antimicrobial agents. This article reviews the factors and the strategies responsible for the survival and persistence of <i>C. sakazakii</i> in PIF. Particularly, studies focused on the influence of various factors on thermal resistance, antibiotic or antimicrobial resistance, virulence potential and stress-associated gene expression are reviewed.