Updated: Multistate Cluster of Carbapenem-Resistant Pseudomonas aeruginosa Linked to Use of Artificial Tears

The Centers for Disease Control and Prevention (CDC) issued a statement recently, urging the immediate discontinuation of the use of EzriCare Artificial Tears until epidemiological investigation and laboratory analyses are complete.

EzriCare Artificial Tears are eye drops containing 1% Carboxymethylcellulose Sodium designed to relieve eye irritation and dryness. According to the CDC, these lubricant eye drops are preservative-free. These eye drops are dispensed in multidose bottles.

The CDC has linked these eye drops to a "multistate cluster of Verona Integron‐mediated Metallo‐β‐lactamase (VIM)‐ and Guiana‐Extended Spectrum‐β‐Lactamase (GES) producing carbapenem‐resistant Pseudomonas aeruginosa (VIM‐GES‐CRPA) associated with multiple different types of infections, including eye infections." In addition to demonstrating carbapenem resistance, isolates in this cluster have shown resistance to ceftazidime and cefepime.

The CDC reported 10 patient cases had eye involvement with one case of permanent vision loss. There has also been one death reported.

"This investigation unfortunately reiterates the significance of ensuring that all ophthalmic andoptometric devices are cleaned, disinfected, and sterilized in accordance with the manufacturer’s instructions for use, based on the intended use of the device," Katharine Hoffman, MPH, CIC, NCMA, LSSGB, infection prevention community health program manager at JPS Health Network in Fort Worth, Texas. "It is crucial that with any contact with non-intact skin, mucous membranes, or normally sterile tissue, that there is strict adherence to Spaulding Classification and evidence-based guidelines. The reprocessing of reusable medical devices must be achieved in a linear manner to best support both patient and staff safety. A breach or omission in reprocessing could increase the risk of an outbreak and could be further complicated by antimicrobial resistant organisms such as Carbapenem‐Resistant Pseudomonas aeruginosa (CRPA). Additionally, standard precautions to include effective hand hygiene also supports high-quality, safe patient care through further mitigating the risk of cross-contamination by breaking the chain of infection."

The cluster identified by the CDC, in partnership with state and local health departments, contains 56 isolates from 50 case-patients from 11 states (CA, CO, CT, FL, NJ, NM, NY, NV, TX, UT, and WA). The date of specimen collection is from May to December 2022, and isolates came from the corneum, sputum or bronchial wash, urine, other nonsterile sources, blood, and rectal swabs.

Patient outcomes in this cluster have included permanent vision loss resulting from ocular infection, hospitalization, and the death of one patient with a bloodstream infection.

Exposures were reviewed for each patient, and the majority of patients used artificial tears. The most common brand reported among patients in the cluster was EzriCare Artificial Tears.

Individuals who use this product should follow the CDC’s recommendation and discontinue current usage. Contact your health department’s healthcare-associated infections contact for submitting isolates.

For users of lubricating eye drops, it is always recommended to avoid touching the tip of the container to any surface- including the user’s eyelids or lashes. Always wash your hand before and after the use of eye drops. It is also recommended to follow the provided instructions for use and storage. The American Academy of Ophthalmology states to never share eye drops, whether prescription or over the counter. Sharing eye drops increases your risk of infections, primarily eye infections. If you have questions regarding instructions for eye drops, always ask your doctor.