Cahill et al evaluated risk factors for Gram-negative bacterial infection in infants drinking powdered formula. Powdered infant formula is not sterile and may be associated with life-threatening infections in infants. The authors are from the United Nations and the World Health Organization.


Pathogens most commonly associated with powdered formula:

(1) Salmonella enterica or other species

(2) Enterobacter sakazakii

(3) other enteric Gram-negative bacteria


Infections that may occur:

(1) diarrhea

(2) bacteremia

(3) meningitis


Risk factors for serious infection:

(1) poor process control at the production plant resulting in high level contamination

(2) poor quality product (which might be all that is available to a person in a developing country)

(3) infant with defective immunity

(4) neonates <= 28 days old and/or preterm

(5) caregivers unaware of the risks or association with the formula

(6) cross contamination during storage and preparation

(7) improper storage (unrefrigerated storage of reconstituted formula)


Reconstitution with water >= 70°C should minimize the risk associated with low level contamination.


Many cases may go unrecognized and so the magnitude of the problem is greater than most people realize.


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