Drug-resistant Pseudomonas aeruginosa Associated with Artificial Tears

A multi-state outbreak involving infections with a carbapenem-resistant Pseudomonas aeruginosa with Verona integron-mediated metallo-β-lactamase and Guiana extended-spectrum-β-lactamase (VIM-GES-CRPA) has identified artificial tears as a common exposure. No outbreak-associated infections have been reported to Idaho public health officials. On February 3, 2023, the Food and Drug Administration (FDA) announced Global Pharma Healthcare voluntarily recalled all lots within expiry of their Artificial Tears Lubricant Eye Drops, distributed by EzriCare, LLC- and Delsam Pharma, due to possible contamination. The Idaho Healthcare Associated Infections Program and the Idaho Bureau of Laboratories (IBL) in Department of Health and Welfare and Idaho’s public health districts are working together to identify multidrug-resistant organisms (MDROs).

Recommendations for Idaho Healthcare Providers:

• At this time, public health officials do not recommend testing patients who have used this product and who are not experiencing any signs or symptoms of infection.
• Advise patients who used EzriCare Artificial Tears to discontinue use of the product and monitor for signs and symptoms of infection.
• If treating patients for keratitis or endophthalmitis, ask patients if they have used EzriCare Artificial Tears. Consider performing culture and antimicrobial susceptibility testing to help guide therapy if patients report use of this product.
• If treating VIM-GES-CRPA infections, consult with a specialist knowledgeable in the treatment of antibiotic-resistant bacteria to determine the best treatment option. VIM-GES-CRPA isolates associated with this outbreak are extensively drug-resistant. Isolates that underwent susceptibility testing at public health laboratories were not susceptible to cefepime, ceftazidime, piperacillin-tazobactam, aztreonam, carbapenems, ceftazidime-avibactam, ceftolozane-tazobactam, fluoroquinolones, polymyxins, amikacin, gentamicin, and tobramycin. A subset of 3 isolates that underwent antimicrobial susceptibility testing for cefiderocol at clinical laboratories or CDC were susceptible to this agent.
• Place patients infected or colonized with VIM-GES-CRPA and admitted to acute care settings in isolation and use Contact Precautions. For residents of skilled nursing facilities who are infected or colonized with VIM-GES-CRPA, use Enhanced Barrier Precautions if the resident does not have an indication for Contact Precautions.
• Report suspected or confirmed infections to public health officials.

For questions or assistance with forwarding specimens, please contact the Idaho Bureau of Laboratories at (208) 334-2235.

For additional information and if a carbapenem resistant organism is identified, please contact Central District Health at (208) 327-8625, the Idaho Epidemiology Section at (208) 334-5939, or the Idaho Healthcare Associated Infections Program at (208) 334-5871.

Resources:

CDC HAN: https://emergency.cdc.gov/han/2023/han00485.asp

CDC Clinical Information: https://www.cdc.gov/hai/outbreaks/CRPA-artificial-tears.html

FDA Voluntary Recall: https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/global-pharma-healthcare-issues-voluntary-nationwide-recall-artificial-tears-lubricant-eye-drops-due

Idaho Department of Health and Welfare: https://healthandwelfare.idaho.gov/

Idaho Public Health Districts: https://healthandwelfare.idaho.gov/health-wellness/community-health/public-health-districts

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