The Centers for Disease Control and Prevention (CDC) is investigating a multistate outbreak of carbapenem-resistant Pseudomonas aeruginosa linked to eye drops and one death.
In a Jan 20 statement, the CDC said it identified 56 isolates of Verona integron-mediated metallo beta-lactamase and Guiana extended-spectrum beta-lactamase–producing carbapenem-resistant P aeruginosa (VIM-GES-CRPA) from 50 case patients in 11 states from May 17, 2022, to Jan 19. Thirty-eight cases are part of four facility clusters. Whole-genome sequencing data indicate that all isolates are closely related.
The isolates were collected in outpatient and inpatient healthcare settings in California, Colorado, Connecticut, Florida, New Jersey, New Mexico, New York, Nevada, Texas, Utah, and Washington. The isolates were associated with multiple different infection types, including eye infections, and colonization. Patient outcomes include permanent vision loss and one death from a bloodstream infection.
Review of common exposure among patients revealed that most patients used artificial tears prior to the identification of VIM-GES-CRPA infection or colonization, with EzriCare Artificial Tears the most commonly used brand. Lab testing of the product by the CDC identified the presence of VIM-GES-CRPA in opened bottles.
In a statement today, EzriCare said, "As of today, we are not aware of any testing that definitively links the Pseudomonas aeruginosa outbreak to EzriCare Artificial Tears. Nonetheless, we immediately took action to stop any further distribution or sale of EzriCare Artificial Tears."
We immediately took action to stop any further distribution or sale of EzriCare Artificial Tears.
In addition to carbapenem resistance, isolates in the cluster are resistant to ceftazidime and cefepime, and a subset of isolates is also resistant to ceftazidime-avibactam and ceftolozane-tazobactam. The CDC says P aeruginosa strains harboring both VIM and GES genes have not previously been observed in the United States.
The CDC is asking clinical labs that identify any CRPA from an ocular specimen or VIM-CRPA from any specimen to submit the isolates to the Antimicrobial Resistance Laboratory Network for further analysis.