In 1994 an outbreak attributed to Enterobacter sakazakii occurred in a French neonatal intensive care unit. Four babies died due to meningitis and necrotizing enterocolitis. Since the first analysis of the strains was published in 2007 there have been at least 30 further papers using these specific outbreak strains. This article reviews the improvements in our understanding of the organism, now known as the genus Cronobacter, that are due to the progressive research into this single outbreak. These developments include a curated open access, expansive multi-locus sequence typing database (Cronobacter PubMLST; 7 loci MLST, 53 loci ribosomal-MLST, and 1836 loci core genome-MLST), recognition of pathovars, virulence traits, and whole genome sequence analysis leading to K-antigen recognition, CRISPR-cas array and capsule encoding gene profiling, as well as SNP-based re-analysis of the outbreak strains. Together these show how conventional typing methods can fail to distinguish unrelated strains due to the high clonality within the target species, and that current techniques in microbial source tracking need to be DNA-sequence based in order to improve control of this pathogen and reduce the risk of infection to neonatal health.
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