New York and New Jersey are among 12 states implicated in a small outbreak of “extremely” drug-resistant bacteria, according to an alert released late Wednesday by the Centers for Disease Control and Prevention. The CDC has linked several of the cases to EzriCare Artificial Tears, a brand of over-the-counter eye drops.
The germ is a rare mutant strain of Pseudomonas aeruginosa, a type of bacteria commonly found in fresh water, soil, and other environmental media.
But in recent years, antibiotic-resistant forms of the bacteria have become a scourge in healthcare settings because they easily survive on surfaces, forming “biofilms” on equipment and devices. It can also spread through contaminated hands. To cause an infection, the germ must pass through the skin – via a needle stick during an IV, for example, or via an organ transplant.
But Pseudomonas aeruginosa can also invade the body through a person’s moist, skinless eyes. These infections usually occur when people wear contact lenses for too long.
Of the 55 cases identified so far, 35 patients are linked to clusters in four health facilities. So far, one patient has died and others have been hospitalized or suffered permanent vision loss.
Many, but not all, patients developed eye infections, and most used artificial tears or lubricating eye drops. Although patients told investigators of more than 10 different brands, the most common was EzriCare Artificial Tears.
“Patients and healthcare providers should immediately discontinue use of EzriCare artificial tears pending further information and guidance from the CDC and FDA,” the CDC said.
The CDC said subsequent testing of opened EzriCare bottles detected a strain of Pseudomonas aeruginosa resistant to a dozen antimicrobial drugs. But federal health investigators found that the germ is still susceptible to the antibiotic cefiderocol. The CDC said it continues to test unopened bottles to see if contamination occurred during the manufacturing process.
In a statement posted on its website on Wednesday, EzriCare wrote that its artificial tear product is manufactured in India by Global Pharma Healthcare PVT Limited and imported into the United States by Aru Pharma Inc. The company is based in Lakewood, New Jersey.
“EzriCare LLC’s sole role in bringing the product to market was to design an outer label and market it to our customers,” the company said. “We understand that the same product is also marketed under other brand names. We understand that Global Pharma Healthcare PVT Limited will be issuing a product recall.
The company said it is contacting customers to advise them against using its product. The CDC said healthcare providers treating new or current patients with ocular inflammation should ask them if they have recently used EzriCare artificial tears.
Pseudomonas aeruginosa is one of many bacteria known to acquire the ability to resist drugs. According to CDC data, multidrug-resistant forms of Pseudomonas aeruginosa hospitalized 32,600 people in 2017 and killed 2,700.
The same report shows that prior to the COVID-19 pandemic, levels of this germ were declining due to infection control efforts. But this and other antibiotic-resistant germs have rebounded during the pandemic. The CDC estimates that more than 2.8 million antimicrobial resistant infections occur each year, resulting in more than 35,000 deaths.