Deciphering Cronobacter sakazakii Pathogenesis: From Host Invasion to Future Directions

Cronobacter sakazakii is a formidable foodborne pathogen that poses a severe, often fatal threat to neonates and immunocompromised individuals, with contaminated powdered infant formula as the primary transmission vehicle. Infections can lead to devastating conditions, such as meningitis, necrotizing enterocolitis, and sepsis, with alarmingly high mortality rates. Clinical management is hampered by the lack of standardized treatment guidelines and the emergence of antibiotic resistance. However, ongoing research into its molecular pathogenesis continually covers novel targets for intervention. In this review, we synthesize recent advances in our understanding of the sophisticated mechanisms that enable C. sakazakii to cause disease. We argue that its virulence hinges on a multi-faceted strategy, including efficient host invasion and tissue penetration via outer membrane proteins, sophisticated immune evasion tactics for intracellular survival, a repertoire of regulated virulence determinants, resilient biofilm formation, and robust stress response systems that ensure environmental persistence. As research continues to decipher these intricate host–pathogen interactions, we highlight promising future directions, including the development of rapid on-site diagnostics, the application of effective biocontrol strategies like phage therapy and probiotics, and the formulation of targeted therapeutic regimens. Ultimately, integrating these multifaceted insights is paramount to developing comprehensive strategies for preventing and controlling the global health burden imposed by C. sakazakii.