A simple and rapid cultural method for detection of Enterobacter sakazakii in environmental samples

A method was developed to detect and identify Enterobacter sakazakii in environmental samples. The method is based on selective enrichment at 45+/-0.5 degrees C in lauryl sulfate tryptose broth supplemented with 0.5 M NaCl and 10 mg/liter vancomycin (mLST) for 22 to 24 h followed by streaking on tryptone soy agar with bile salts. When exposed to light during incubation at 37 degrees C, E. sakazakii produces yellow colonies within 24 h; identification was confirmed by testing for alpha-glucosidase activity and by using API 20E strips. All of the E. sakazakii strains tested (n = 99) were able to grow in mLST at 45+/-0.5 degrees C, whereas 35 of 39 strains of potential competitors, all belonging to the Enterobacteriaceae, were suppressed. A survey was carried out with 192 environmental samples from four different milk powder factories. Using this new protocol, E. sakazakii was isolated from almost 40% of the samples, whereas the reference procedure (enrichment in buffered peptone water, isolation on violet red bile glucose agar, and biochemical identification of randomly chosen colonies) only yielded 26% positive results. This selective method can be very useful for the rapid and reliable detection of E. sakazakii in environmental samples.     

A chromogenic plating medium for the isolation and identification of Enterobacter sakazakii from foods, food ingredients, and environmental sources

A chromogenic agar, R&F Enterobacter sakazakii chromogenic plating medium (ESPM), was developed for isolating presumptive colonies of E. sakazakii from foods and environmental sources. ESPM contains two chromogenic substrates (5-bromo-4-chloro-3-indoxyl-alpha-D-glucopyranoside and 5-bromo-4-chloro-3-indoxyl-beta-D-cellobioside), three sugars (sorbitol, D-arabitol, and adonitol), a pH indicator, and inhibitors (bile salts, vancomycin, and cefsulodin), which all contribute to its selectivity and differential properties. On ESPM, 79 pure culture strains of E. sakazakii (10 clinical isolates and others from food and environmental sources) yielded blue-black (three strains were blue-gray) raised colonies, 1 to 2 mm in diameter with and without halos after 24 h at 35 degrees C. Other enteric organisms plus Pseudomonas aeruginosa yielded white, yellow, green, or clear colonies with and without clear halos. Of these genera, only Shigella sonnei and one Pantoea strain produced blue-black to blue-gray colonies. ESPM was used to isolate E. sakazakii from a variety of foods: corn, wheat, and rice flours; powdered infant formula; dairy products (dried milk, whey, and caseinates); cereals; and environmental sources. Most false-positive results on ESPM were eliminated by observing acid production on either sucrose or melibiose after 6 h at 35 degrees C on a R&F E. sakazakii screening medium (ESSM) biplate. In an analysis of 240 samples, the number of samples positive for E. sakazakii by the ESPM-ESSM method and the U.S. Food and Drug Administration protocols (violet red bile glucose agar and tryptic soy agar) were 27 and 16, respectively, with sensitivity and specificity values of 100.0 and 96.9% versus 59.3 and 43.7%, respectively. These data support the fact that E. sakazakii confirmation should be based on more than one confirmation system. Both the API 20E and Biolog Microlog3 4.20 systems should be used for confirmation of E. sakazakii isolates.     

环介导等温扩增法快速检测乳中阪崎肠杆菌

利用环介导等温扩增方法的快速、简便等优点,建立一种检测乳中阪崎肠杆菌的方法。以阪崎肠杆菌的OmpA序列为靶基因,设计特异性引物。优化并建立LAMP检测乳中阪崎肠杆菌的方法。结果表明,LAMP检测阪崎肠杆菌纯培养物的灵敏度为3.7×101cfu/mL,其灵敏度是PCR方法的10倍。人工污染阪崎肠杆菌灭菌乳的检测限为4.3×101cfu/mL。对23株致病菌进行特异性实验,特异性良好。该方法具有特异性强、灵敏度高、设备简便、耗时短等优点,在食品检测中具有良好的应用前景。      

A selective differential medium for Enterobacter sakazakii, a preliminary study

Enterobacter sakazakii can cause fatal invasive infection of neonates associated with the presence of this organism in powdered infant milk formula. A new chromogenic medium (Druggan-Forsythe-Iversen agar, DFI) is described for the selective detection of this emergent pathogen. The medium is based on the alpha-glucosidase reaction which is detected using 5-bromo-4-chloro-3-indolyl-alpha,D-glucopyranoside (XalphaGlc). Ent. sakazakii hydrolyses this substrate to an indigo pigment, producing blue-green colonies on this medium. DFI was compared with the current method of detection on violet red bile glucose agar (VRBGA) followed by pigment production on tryptone soy agar (TSA) after 48-72 h at 25 degrees C and subsequent biochemical profile determination using Biomerieux API20E. Ninety-five clinical and food strains of Ent. sakazakii were detected on the DFI chromogenic medium 2 days sooner than the alternative method. The characteristics of 148 strains representing 17 genera of non-Ent. sakazakii Enterobacteriaceae were compared using the two methods. Only 16/18 Escherichia vulneris strains, 2/3 strains of Pantoea spp. and 1/8 Citrobacter koseri strains gave false positive results on DFI agar. Eight alpha-glucosidase positive strains were identified as Pantoea using their API20E biochemical profile, but had higher percentage identification as Ent. sakazakii using ID32E. Therefore the DFI medium enables the detection of Ent. sakazakii within mixed cultures of Enterobacteriaceae, whereas the organism could be missed when using VRBGA since the latter is a general Enterobacteriaceae selective medium. In addition, the common use of API20E to check yellow pigmented colonies on TSA may lead to false negative results and consequently the acceptance of a batch of infant formula milk (IFM) that contains Ent. sakazakii.     

乳粉中阪琦肠杆菌的PCR检测

针对我国食品进出口和生产卫生的需要,使用以16 S rRNA基因为靶序列设计合成了一对可扩增282 bp的目的片段的引物,建立了检测阪琦肠杆菌的PCR方法.结果表明,阪琦肠杆菌PCR产物有282 bp的特异性片段,而金黄色葡萄球菌无此目的条带,证实该引物具有特异性.该方法快速、可靠、灵敏,特异性强,可用于食品中阪琦肠杆菌的检测.     

抑制阪崎肠杆菌的乳酸菌筛选及其抗菌物质特性研究

目的 从酸菜和大弹涂鱼肠道中分离可产抑制阪崎肠杆菌活性的乳酸菌,并对抑菌物质的特性和抑菌机制进行研究,为其在食品保鲜中的应用奠定基础。方法 利用抑菌圈实验从分离所得的多株乳酸菌中筛选具有抑制阪崎肠杆菌活性的菌株并鉴定,排除酸及过氧化氢的影响后,分析其抑菌产物的特性。分离纯化抑菌物质,并初步探讨抑菌机制。结果 筛选得到一株抑菌效果最好的乳酸菌SA3,经鉴定为发酵黏液乳杆菌(Limosilactobacillus fermentum),其上清液对阪崎肠杆菌抑菌圈直径达到16.94 mm。上清液具有蛋白特性和热稳定性,以乙酸乙酯粗提出的抑菌物质对鼠伤寒沙门氏菌、白色念珠菌、大肠埃希氏菌等致病菌表现出较强抑菌活性。其抑菌机制为乳酸菌所产抑菌物质可破坏阪崎肠杆菌的细胞壁及内容物。结论 本研究分离到的发酵黏液乳杆菌SA3有望应用于乳制品中阪崎肠杆菌的生物防腐。     

克罗诺杆菌属(阪崎肠杆菌)的分离与鉴定能力验证结果与分析

目的 通过参加“奶粉中克罗诺杆菌属(阪崎肠杆菌)的检测能力验证计划”,验证实验室对克罗诺杆菌属(阪崎肠杆菌)的检测能力,提高实验室检测技能。方法 依据GB 4789.40-2016 《食品安全国家标准 食品微生物学检验 克罗诺杆菌属(阪崎肠杆菌)检验》中的第一法,对能力验证样品进行检验,对分离出的可疑菌落进行生化鉴定,同时用BIOLOG鉴定系统对可疑菌落进行鉴定。 结果 编号G785和编号V995的两个能力验证样品皆检出克罗诺杆菌属(阪崎肠杆菌) 结论 本次能力验证获得满意结果,证明本实验室具备克罗诺杆菌属(阪崎肠杆菌)的检测能力。在本次能力验证实验过程中,在以国标法检测的同时,辅以BIOLOG进行鉴定,与传统生化鉴定结果互为印证,提高了检测结果的准确性,对以后的检测工作具有一定的参考价值。     

Rapid, specific detection of Enterobacter sakazakii in infant formula using a real-time PCR assay

Enterobacter sakazakii is a rare cause of invasive infection with high mortality rates in neonates. Powdered milk-based infant formulas have been associated with the E. sakazakii-related outbreaks in premature or other immunocompromised infants. In this study, an assay was developed for the specific detection of E. sakazakii in infant formula using an application of the fluorogenic 5' nuclease assay (TaqMan). A set of primers and probe was designed using the E. sakazakii partial macromolecular synthesis operon: the rpsU gene 3' end and the primase (dnaG) gene 5' end. The specificity of the assay was evaluated using 68 Enterobacter and 55 non-Enterobacter strains. The newly developed assay enables us to detect 100 CFU/ ml in pure culture and in reconstituted infant formula in 50 cycles of PCR without enrichment. The assay was specific enough to discriminate E. sakazakii from all other Enterobacter and non-Enterobacter strains tested. The developed real-time PCR assay could save up to 5 days and eliminate the need for plating samples on selective or diagnostic agars and for biochemical confirmation steps. The real-time PCR assay could be used to rapidly screen infant formula samples for E. sakazakii and would be a boon to food industries and regulatory agencies.     

Evaluation of different methods for the detection and identification of Enterobacter sakazakii isolated from South African infant formula milks and the processing environment

Enterobactersakazakii is an emerging pathogen associated with life-threatening neonatal infections resulting from the consumption of contaminated powdered infant formula milk (IFM). Recent taxonomic analyses have determined that E. sakazakii comprises a number of genomospecies, and it has been proposed that E. sakazakii be reclassified as a novel genus, "Cronobacter". Accurate methods are required for the rapid detection and identification of this group of micro-organisms, since even low cell numbers have been reported to cause disease. The aim of this study was to evaluate various E. sakazakii detection methods in order to ascertain the most suitable method for detection and identification of these pathogenic agents. Samples from IFM and the environment were evaluated for the presence of E. sakazakii using the isolation steps (pre-enrichment, enrichment and selection) described in the Food and Drug Administration (FDA) method for E. sakazakii detection. Sixty-four isolates (50 from IFM and 14 from the environment) were selected from tryptone soy agar (TSA), regardless of colony appearance, and these isolates were identified by 16S ribosomal DNA (rDNA) sequencing. Thereafter, different culture-dependent and culture-independent methods were evaluated to accurately detect and identify the E. sakazakii isolates. These methods included the assessment of yellow pigment production on TSA, typical colonies on chromogenic Druggan-Forsythe-Iversen (DFI) and Chromocult(R) Enterobacter sakazakii (CES) media and polymerase chain reaction (PCR) using six different species-specific primer pairs described in the literature. Identification of E. sakazakii using yellow pigment production was demonstrated to have a low sensitivity, specificity and accuracy (87%, 71% and 74%, respectively), which lowers the suitability of the FDA method. Chromogenic DFI and CES media were sensitive, specific and accurate (100%, 98% and 98%, respectively) for the detection of E. sakazakii. The specificity of the PCR amplifications ranged from 8% to 92%, emphasising the need for rigorous primer testing against closely related species. Of the primer pairs evaluated, Esakf/Esakr were the most suitable for E. sakazakii detection and identification. The detection limit of Esakf/Esakr was found to be 10(4) CFU/ml. This study demonstrated that no single method was capable of unambiguously confirming the presence and identity of E. sakazakii isolates, that each method had inherent advantages and disadvantages, and that in most cases several methods were required for accurate detection and identification. Further, it was demonstrated that the current FDA method for E. sakazakii detection should be revised in the light of the availability of more sensitive, specific and accurate detection methods.     

恒温实时荧光法快速检测奶粉中阪崎肠杆菌方法的建立

为实现奶粉中快速检测阪崎肠杆菌,本文建立了检测阪崎肠杆菌的恒温实时荧光法。针对阪崎肠杆菌16S r RNA设计三组LAMP引物,采用Deaou-308C恒温实时荧光检测平台,选取常见病原菌标准株进行引物特异性检测;选取阪崎肠杆菌标准菌株进行基因组DNA灵敏度和最低检测限测定,同时利用人工污染方式检测此方法在脱脂和全脂奶粉中的灵敏度和最低检测限,利用Real Amp法和国标法对20份市售奶粉进行对比实验。结果显示,引物组16S-11扩增效率最优,与常见病原菌无交叉反应,对阪崎肠杆菌基因组DNA、阪崎肠杆菌污染的脱脂和全脂奶粉的灵敏度分别达到102 CFU/m L、102 CFU/m L和103 CFU/m L;对阪崎肠杆菌基因组DNA和阪崎肠杆菌污染的脱脂和全脂奶粉的最低检测限分别达到103 CFU/m L、103 CFU/m L和104 CFU/m L;在20份市售奶粉样品中Real Amp检测结果与传统国标培养结果一致,表明本文建立的阪崎肠杆菌Real Amp检测方法适用于阪崎肠杆菌的快速检测。     

Characterization of a collection of Enterobacter sakazakii isolates from environmental and food sources

Enterobacter sakazakii has emerged as a rare cause of neonatal meningitis, septicemia and enterocolitis. Contaminated infant milk formula (IMF) has been identified as one infection route. A small number of clinical outbreaks have been epidemiologically linked to IMF contaminated post-pasteurization during manufacture and/or mishandled when reconstituted. Currently no agreed standardized typing protocol has been developed to trace E. sakazakii. The objectives of this study were to apply biochemical and genetic methods to characterize 51 environmental and food E. sakazakii isolates and 6 E. sakazakii type strains. Isolates were presumptively identified using biochemical profiles based on API 20E and ID32E methods and by culture on differential selective Druggan Forsythe Iversen (DFI) agar. Identification was subsequently confirmed by real time polymerase chain reaction (PCR). All but one of the isolates was identified as E. sakazakii by biochemical profiling. One isolate was identified as Escherichia vulneris by ID 32E and as Pantoea agglomerans by API 20E. All isolates produced green/blue colonies on DFI medium characteristic of this organism. Real time PCR could differentiate between E. sakazakii, Enterobacter spp. and other Enterobacteriacae. Analysis of RAPD banding patterns revealed 3 major clusters of E. sakazakii. There was a large degree of diversity noted amongst the remaining isolates. Our findings indicate that RAPD may be applied as a useful and reliable tool for direct comparison of E. sakazakii isolates providing traceability through the infant formula food chain.     

DETECTION AND DISCRIMINATION OF ENTEROBACTER SAKAZAKII (CRONOBACTER SPP.) BY MID-INFRARED SPECTROSCOPY AND MULTIVARIATE STATISTICAL ANALYSES

Enterobacter sakazakii can cause rare but life-threatening diseases such as meningitis in infants and neonates. Fourier transform infrared (FT-IR) spectroscopy was used to detect and discriminate between eight E. sakazakii strains, two Enterobacter cloacae strains, three Escherichia coli strains and two Klebsiella pneumoniae strains. FT-IR vibrational combination bands reflect subtle compositional differences in the cell membranes of E. sakazakii strains, especially in the region between 1,200 and 900 cm ^{− 1} which contains absorption bands from carbohydrates. Two multivariate statistical analyses including principal component analysis (PCA) and soft independent modeling of class analogy (SIMCA) were used for data analysis. E. sakazakii strains were clearly distinguishable from the other strains by PCA. Based upon SIMCA analysis, 90% of E. sakazakii, 88% of E. cloacae, 91% of E. coli and 91% of K. pneumoniae samples were correctly classified, suggesting that this technique could be used to detect E. sakazakii strains rapidly and accurately.

PRACTICAL APPLICATIONS

Fourier transform infrared (FT-IR) coupled with multivariate statistical analyses can be used to detect, discriminate and identify Enterobacter sakazakii strains that have been implicated in food safety incidents caused by contaminated infant formula. Compared with traditional microbiological plating methods, this new approach of using FT-IR could be an alternative means for rapid and accurate detection of bacterial samples that are important in agricultural, food and medical areas.     

奶粉中一株阪崎肠杆菌的鉴定及其挥发性产物分析

目的鉴定奶粉中一株阪崎肠杆菌分离菌株F2-1,采用顶空气相色谱-质谱联用法(headspace gas chromatography-mass spectrometry,HS-GC-MS)分析分离菌株F2-1在液态培养中产生的挥发性代谢产物。方法应用VITEK 2 Compact全自动微生物鉴定系统分析分离菌株的生理生化特征;利用环介导等温扩增技术(loop-mediated isothermal amplification,LAMP)特异性扩增检测分离菌株的16S rDNA,通过HS-GC-MS分析分离菌株F2-1代谢的挥发性产物。结果分离菌株F2-1为革兰氏阴性菌,生理生化特征与阪崎肠杆菌(Enterobacter sakazakii,ES)的相似性为99%,LAMP检测进一步确认为阪崎肠杆菌,分离菌株F2-1在营养肉汤中代谢的挥发性产物主要有异戊醛、乙醇、异戊醇、3-羟基-2-丁酮、乙酸、正十五烷、正十六烷、正十七烷、1-癸醇。结论奶粉中分离菌株F2-1鉴定为阪崎肠杆菌,该菌产生的挥发性产物为阪崎肠杆菌的快速鉴定提供参考。     

Enterobacter sakazakii in food and beverages (other than infant formula and milk powder)

The ubiqitous microorganism Enterobacter sakazakii is a rare contaminant of infant formula and may cause severe systemic infection in neonates. So far, other food is not known to cause E. sakazakii-infections. The scarce information about the ecology of E. sakazakii and the uncertainty concerning the source of infection in children and adults warrant a summary of the current knowledge about the presence of this opportunistic microorganism in food other than infant formula. This review systematizes publications on the presence of E. sakazakii in food and beverages until June 2006. Food other than infant formula has been rarely investigated for the presence of E. sakazakii. Nevertheless, this microorganism could be isolated from a wide spectrum of food and food ingredients. E. sakazakii was isolated from plant food and food ingredients like cereal, fruit and vegetables, legume products, herbs and spices as well as from animal food sources like milk, meat and fish and products made from these foods. The spectrum of E. sakazakii-contaminated food covers both raw and processed food. The kind of processing of E. sakazakii-contaminated food was not restricted to dry products. Fresh, frozen, ready-to-eat, fermented and cooked food products as well as beverages and water suitable for the preparation of food, were found to be contaminated by E. sakazakii. Although E. sakazakii-contaminated food do not have general public health significance, measures for prevention should consider the presence of E. sakazakii in food, food ingredients, their processing and preparation as possible source of contamination, colonization or infection.     

阪崎肠杆菌-食品安全控制的新目标

自 196 1年英国首次报道阪崎肠杆菌引起婴儿脑膜炎病例以来 ,世界上相继有多个国家报道了新生儿阪崎肠杆菌感染事件 ,婴儿配方奶粉与疾病的暴发密切相关。在 2 0 0 3年第 35次食品卫生法典大会上 ,美国和加拿大提出了有关控制婴幼儿配方奶粉中阪崎肠杆菌的危险性框架 ,指出 1岁以下的易感婴幼儿感染阪崎肠杆菌后有生命危险。 2 0 0 4年第 36次食品卫生法典大会一致通过并设立了以加拿大为首的起草工作组 ,加速修订婴幼儿食品国际卫生操作规范 ,制定阪崎肠杆菌和其它可能导致婴幼儿健康危害的相关病原菌的微生物标准。     

Effect of desiccation, starvation, heat, and cold stresses on the thermal resistance of Enterobacter sakazakii in rehydrated infant milk formula

Enterobacter sakazakii is an opportunistic foodborne pathogen that has been isolated from powdered infant milk formula. This study determined the effect of desiccation, starvation, heat and cold stresses on the thermal inactivation of E. sakazakii in rehydrated infant milk formula (RIMF). Stressed cells were mixed with RIMF at 52, 54, 56, and 58 degrees C for various time periods. The D- and z-values were determined by using linear regression analysis. D-values for unstressed E. sakazakii at 52, 54, 56, and 58 degrees C were 15.33, 4.53, 2, and 0.53 min, respectively. Desiccation and heat stresses, but not starvation or cold stress, caused significant (P < 0.05) reduction in D-values. The z-values of desiccated, starved, heat stressed, and cold stressed E. sakazakii were not significantly different from unstressed cells (4.22 degrees C). Thermal resistance of E. sakazakii in RIMF is affected by the environmental stresses; that is, desiccation and heat stresses that may surround the bacterium prior to the contamination of infant formula. The results of this study may be of use to regulatory agencies, infant milk producers, and infant caregivers to design heating processes to eliminate E. sakazakii that may be present in infant milk formula.     

应用DiversiLab分型系统对奶制品中的阪崎肠杆菌进行同源性分析

为研究奶制品污染中阪崎肠杆菌的同源性关系,并建立起阪崎肠杆菌基于重复序列的分型技术。对2005-2006年福建省出入境检验检疫局从各类奶制品中分离出的阪崎肠杆菌先进行API鉴定,然后进行DiversiLab分型。其中DiversiLab分型包括:DNA提取,rep-PCR和微电泳芯片分离检测。rep-PCR条件为:94℃预变性2 min;94℃变性30 s,55℃退火30 s,70℃延伸90 s,35个循环;最后70℃延伸3 min。结果表明:31株阪崎肠杆菌被API分成了5种不同的生物型,DiversiLab分型能将阪崎肠杆菌分为不同的亚型,但它们之间没有必然的联系。部分同一企业来源的菌株具有同源性,样品的同源性与采样地无关。DiversiLab分型系统是一种快速,高效,易于操作,高重复性,高分辨率的基因分型方法,可作为食源性污染的同源性分型工具。     

Cellulose as an extracellular matrix component present in Enterobacter sakazakii biofilms

Cellulose was identified and characterized as an extracellular matrix component present in the biofilm of an Enterobacter sakazakii clinical isolate grown in nutrient-deficient (M9) medium. Using a bacterial artificial cloning approach in Escherichia coli and subsequent screening of transformants for fluorescence on calcofluor plates, nine genes organized in two operons were identified as putatively responsible for the biosynthesis of cellulose. In addition to the genes already described for cellulose production, two more genes were identified, putatively transcribed together with the genes from the first operon. Putative cellulose in E. sakazakii ES5 biofilm grown on glass coverslips was visualized by calcofluor staining and confocal fluorescence laser scanning microscopy. For the first time, the presence of cellulose in biofilms produced by E. sakazakii was confirmed by methylation analysis.     

婴幼儿配方食品中阪崎肠杆菌的计数结果不确定度评定

[目的] 了解专项抽查的婴儿配方食品中的阪崎肠杆菌指标状况,并探讨阪崎肠杆菌的计数结果的不确定度评定方法。[方法] 按照GB 4789.1-2010 《食品微生物学检验 总则》和GB 4789.40-2016 《食品微生物学检验 阪崎肠杆菌检验》进行了抽样和检测, 依据JJF1059.1-2012 《测量不确定度评定与表示》及贝塞尔统计学方法对计数结果进行不确定度评定。[结果]22批次婴儿配方食品中有1批次检出阪崎肠杆菌,检出率为4.55%, 该批次样品中阪崎肠杆菌平均计数为25.5MPN/100g,计数结果扩展标准不确定度为2.72MPN/100g。[结论] 本次评估依据阪崎肠杆菌检计数检验国家标准,对4次保温培养节点进行了分析,结果表明固液混合过程,酵液取样体积,阪崎肠杆菌显色平板上可疑菌落选择和MPN法重复计数的四个不确定度较大,是记数检验过程中的重要环节。     

Comparison of three chromogenic media and evaluation of two molecular-based identification systems for the detection of Enterobacter sakazakii from environmental samples from infant formulae factories

Enterobacter sakazakii is an occasional contaminant of powdered infant formula that can cause rare but severe foodborne infections in infants. To determine optimal methods for the detection and identification of E. sakazakii, 38 naturally contaminated samples from infant formulae factories were analyzed by two PCR-based methods and by a method (TS 22964/RM 210) developed by the International Organization for Standardization and the International Dairy Federation (ISO-IDF) using three different commercial chromogenic agars. The ISO-IDF method includes two enrichment steps, plating of the second enrichment broth on E. sakazakii isolation agar (a chromogenic selective agar), picking of five typical colonies for transfer onto tryptone soy agar, and subsequent confirmation of yellow-pigmented colonies by biochemical characterization. Twenty-two of the 38 samples were positive by the culture method. E. sakazakii isolation agar (ESIA; AES Laboratoires), COMPASS agar (Biokar Diagnostics), and Druggan-Forsythe-Iversen agar (Oxoid) compared favorably with violet red bile glucose agar (VRBG, a selective medium for Enterobacteriaceae), with positive predictive values of 86.96, 88, and 74.07%, respectively, in contrast to 47.83% for VRBG. One additional positive sample was detected using the nonpatented real-time PCR method evaluated, and those results were in 97.3% concordance with the ISO-IDF results. Some discrepancies between the results of the DuPont Qualicon BAX system and those of the ISO-IDF method could be explained by heterogeneity of contamination and sampling. Thus, both PCR-based systems were suitable for detecting and specifically identifying E. sakazakii within 1 to 2 days, and COMPASS agar and ESIA could be used interchangeably as a first-step medium to isolate presumptive E. sakazakii colonies.