ATLANTA—The outbreak of extensively drug-resistant Pseudomonas aeruginosa associated eye drops recalled earlier this year has grown, with 81 cases and four deaths now reported across 18 states, according to the latest update from the Centers for Disease Control and Prevention (CDC). 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 U.S. prior to this outbreak. The outbreak is associated with multiple types of infections, including eye infections.

As of May 15, 2023, the CDC, in partnership with state and local health departments, identified 81 patients in 18 states (CA, CO, CT, DE, FL, IL, NC, NJ, NM, NV, NY, OH, PA, SD, TX, UT, WA, WI) with VIM-GES-CRPA, a rare strain of extensively drug-resistant P. aeruginosa. This represents an increase of 13 patients since the last update.

Among these 13 patients, six (46 percent) had specimens collected prior to the Feb. 2, 2023, manufacturer recall of products associated with this outbreak. These cases were confirmed after the recall date due to the time it takes for testing to confirm the outbreak strain and because of retrospective reporting of infections. Of the seven patients who had specimens collected after the recall, most either resided in long-term care facilities with other known cases or reported use of a recalled brand of artificial tears.

According to the CDC, dates of specimen collection were from May 2022 to April 2023. Adverse outcomes associated with clinical cultures and reported to public health included 14 patients with vision loss, an additional four patients with enucleation (surgical removal of eyeball), and four deaths within 30 days of VIM-GES-CRPA clinical culture collection.

Most patients reported using artificial tears. Patients reported more than 10 different brands of artificial tears, and some patients used multiple brands. EzriCare Artificial Tears, a preservative-free, over-the-counter product packaged in multidose bottles, was the brand most commonly reported. This was the only common artificial tears product identified across the four health care 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 while further characterization of the contaminants is ongoing, noted the CDC in its update.

Three products have been voluntarily recalled by their manufacturer, Global Pharma (Chennai, India), in association with this outbreak, as VMAIL previously reported: EzriCare Artificial Tears, Delsam Pharma Artificial Tears, and Delsam Pharma Artificial Ointment.

No other products have been linked to this outbreak. Patients and health care providers should immediately stop using and discard EzriCare Artificial Tears, Delsam Pharma Artificial Tears, and Delsam Pharma Artificial Ointment, according to the CDC.