The Centers for Disease Control and Prevention (CDC) is collaborating with the Food and Drug Administration (FDA) and state and local health departments to investigate a multistate outbreak of an extensively drug-resistant strain of Pseudomonas aeruginosa.
The outbreak strain, carbapenem-resistant Pseudomonas aeruginosa with Verona integron-mediated metallo-β-lactamase and Guiana extended-spectrum-β-lactamase (VIM-GES-CRPA), had never been reported in the United States prior to this outbreak.
CDC said on May 19 that the number of people with highly drug-resistant bacterial infections linked to contaminated eyedrops has reached 81, up from 68 identified in March. These cases include 14 people who have been blinded and four others who needed to have their eyeballs surgically removed. While most infections have been limited to the eyes, the bacteria can be fatal if it enters the bloodstream. Four people are known to have died from the outbreak, CDC said.
The CDC and FDA investigation has identified EzriCare artificial tears as a common exposure for many patients. CDC and FDA recommend clinicians and patients stop using and discard EzriCare Artificial Tears and two additional products made by the same manufacturer, Delsam Pharma’s Artificial Tears, and Delsam Pharma’s Artificial Ointment. The three products have been voluntarily recalled by their manufacturer, Global Pharma (Chennai, India), in association with this outbreak.
Most patients suffering from the strain reported using artificial tears, with EzriCare Artificial Tears, a preservative-free, over-the-counter product packaged in multidose bottles, the brand most commonly reported. CDC says this was the only common artificial tears product identified across the four healthcare facility clusters. Laboratory testing by CDC identified the presence of VIM-GES-CRPA in opened EzriCare bottles from multiple lots; these bottles were collected from patients with and without eye infections and from two states. VIM-GES-CRPA recovered from opened products match the outbreak strain. Testing of unopened bottles of EzriCare Artificial Tears by FDA identified bacterial contamination; further characterization of the contaminants is ongoing.
