In an update yesterday, the Centers for Disease Control and Prevention (CDC) said 68 patients in 16 states have been identified in the outbreak of a rare strain of extensively drug-resistant Pseudomonas aeruginosa linked to eye drops.
The outbreak, which was first reported by the CDC in January, involves a carbapenem-resistant P aeruginosa (CRPA) strain carrying the Verona integron-mediated metallo-beta-lactamase (VIM) and Guiana extended-spectrum beta-lactamase (GES) genes. Multiple types of infections, including eye infections, have been reported. Of the 68 patients identified by the CDC and state and local health departments as of March 14, 37 were linked to four healthcare facilities. Three patients have died, eight have experienced vision loss, and four have had an eye surgically removed.
Most patients reported using artificial tears, with EzriCare Artificial Tears the most commonly reported brand and the only one used in all four affected healthcare facilities. CDC testing identified the presence of VIM-GES-CRPA isolates in opened bottles from patients with and without infections in two states. CDC is advising the public and healthcare providers to stop using EzriCare and Delsam Pharma's Artificial Tears pending further investigation and guidance and is urging anyone who has used the products and has signs and symptoms of an eye infection to seek care immediately.
The VIM-GES-CRPA isolates are resistant to multiple antibiotics used to treat Pseudomonas infections, including carbapenems, ceftazidime, cefepime, piperacillin-tazobactam, aztreonam, and ceftazidime-avibactam. Prior to the outbreak, P aeruginosa strains carrying this combination of resistance genes had not been seen in the United States. The CDC considers multidrug-resistant P aeruginosa a serious threat.
Given the extensive drug resistance associated with VIM-GES-CRPA, the CDC said bacteriophages with activity against the strain have been identified as a potential treatment option by the University of California at San Diego's Center for Innovative Phage Applications and Therapeutics.