<i>Cronobacter</i> Surveillance in Minnesota, United States, 2002–2024

<i>Cronobacter sakazakii</i> is an opportunistic pathogen associated with bloodstream infections and meningitis in neonates and infants. <i>C. sakazakii</i> isolated from infants under 1 year of age has been reportable in Minnesota since 2003. Invasive <i>Cronobacter</i> infections in infants was recently made notifiable nationally in 2024. Therefore, this summary of over 20 years of reportable surveillance for <i>C. sakazakii</i> from Minnesota infants will inform other jurisdictions. During 2002-2024, 23 <i>C. sakazakii</i> cases in infants, including 8 invasive and 15 non-invasive cases, were identified and confirmed using MALDI-TOF or conventional biochemical methods. Invasive cases were younger (median, 18 days; range, 8 days to 10 months) than non-invasive cases (median, 98 days; range, 7 days to 8 months). <i>Cronobacter</i> isolates from infant (21), child (4), and adult (15) cases were submitted for whole genome sequencing (WGS) to obtain a contextual understanding of potential relatedness. In addition, <i>C. sakazakii</i> isolated from powdered infant formula (PIF) in 2003 was sequenced for comparison. Sequence type (ST) 4 was responsible for the majority of <i>C. sakazakii</i> cases overall (65%) and invasive infant cases (88%). Opened and unopened PIF was cultured from 10 investigations representing both invasive and non-invasive cases. Two (25%) opened PIF samples tested positive for <i>C. sakazakii</i> ST 4 while one (11%) unopened PIF sample tested positive for <i>C. sakazakii</i> ST 4. WGS demonstrated that no clinical cases were associated with a recognized outbreak. Several cases were likely due to contamination of PIF in the home during preparation, highlighting the importance of infant caregiver education to prevent infections.