Occurrence and prevalence of Cronobacter spp. in plant and animal derived food sources: a systematic review and meta-analysis.

Cronobacter species are motile, non-spore forming, Gram negative emerging opportunistic pathogens mostly associated with bacteremia, meningitis, septicemia, brain abscesses and necrotizing enterocolitis in infected neonates, infants and immunocompromised adults. Members of the genus Cronobacter are previously associated with powdered infant formula although the main reservoir and routes of contamination are yet to be ascertained. This study therefore aim to summarize occurrence and prevalence of Cronobacter spp. from different food related sources. A retrospective systematic review and meta-analysis of peer reviewed primary studies reported between 2008 and 2014 for the occurrence and prevalence of Cronobacter spp. in animal and plant related sources was conducted using "Cronobacter isolation", "Cronobacter detection" and "Cronobacter enumeration" as search terms in the following databases: Web of Science (Science Direct) and ProQuest. Data extracted from the primary studies were then analyzed with meta-analysis techniques for effect rate and fixed effects was used to explore heterogeneity between the sources. Publication bias was evaluated using funnel plot. A total of 916 articles were retrieved from the data bases of which 28 articles met inclusion criteria. Cronobacter spp. could only be isolated from 103 (5.7 %) samples of animal related food while 123 (19 %) samples of plant related food samples harbors the bacteria. The result of this study shows that occurrence of Cronobacter was more prevalent in plant related sources with overall prevalence rate of 20.1 % (95 % CI 0.168-0.238) than animal originated sources with overall prevalence rate of 8 % (95 % CI 0.066-0.096). High heterogeneity (I (2) = 84) was observed mostly in plant related sources such as herbs, spices and vegetables compared to animal related sources (I (2) = 82). It could be observed from this study that plant related sources serve as reservoir and contamination routes of Cronobacter spp.