CDC gives update on VIM-GES-CRPA outbreak associated with artificial tears

Thirty-seven patients have been linked to 4 healthcare facility clusters. (Image Credit: AdobeStock/mala)

The Centers for Disease Control and Prevention (CDC) has issued an update on an outbreak associated with artificial tears.

In an updated case count, 68 patients across 16 US states have been infected with VIM-GES-CRPA, a rare strain of extensively drug-resistant Pseudomonas aeruginosa, which has not before been identified in the US according to the CDC. There have been 8 reported patients with vision loss as well as 4 reports of enucleation (surgical removal of eyeball). Thirty-seven patients were linked to 4 healthcare facility clusters.

There have also been 2 additional deaths linked to the eye drops, bringing the total death count to 3, with 1 death previously reported.

As reported previously, most patients infected with VIM-GES-CRPA report using artificial tears, with EzriCare Artificial Tear being the most common. This was the only artificial tear identified across the 4 healthcare facility clusters according to the CDC.

According to the CDC, infections are caused by a strain of carbapenem-resistant Pseudomonas aeruginosa that produces the Verona integron-encoded metallo-β-lactamase (VIM) and the Guiana-Extended Spectrum-β-Lactamase (GES). Isolates are Pseudomonas aeruginosa sequence type (ST) 1203 and harbor bla_VIM-80 and bla_GES-9, a combination not previously identified in the United States.

The CDC reports that VIM-GES-CRPA isolates associated with this outbreak have been extensively drug-resistant.

One of the most alarming aspects of the report, is that the CDC states the infection shows signs of being transmissible. The CDC stated healthcare providers caring for patients with VIM-producing Pseudomonas aeruginosa should follow infection control recommendations to prevent transmission to other patients, as these bacteria “have the potential to spread rapidly in healthcare settings.”

The CDC recommends placing any patient infected with the with VIM-GES-CRPA admitted to acute care settings in isolation and use contact precautions.

In an interview with ARS Technica, Marissa Grossman, a CDC Epidemic Intelligence Service Officer, stated most of the healthcare-linked cases had exposure to the eye drops, but some did not, suggesting person-to-person transmission.

"Patients can carry these organisms on or in their body without showing signs of illness—this is called asymptomatic colonization," said Grossman. “This attribute helps facilitate their silent spread in health care facilities."

Grossman would go on to elaborate on the seriousness of this outbreak.

"To-date, extensively drug-resistant Pseudomonas with genes that rapidly spread resistance, like VIM and GES, have been rare in this country, and typically associated with person-to-person spread in health care facilities," she said. "The widespread introduction of the outbreak strain, which has not been seen before in the US, threatens to undermine efforts to prevent these highly resistant organisms from becoming more common."

Again, CDC and FDA recommend clinicians and patients stop using EzriCare or Delsam Pharma’s Artificial Tears products pending additional guidance from CDC and FDA.

Editor's Note: This article was updated on March 23, 2023 to reflect the additional deaths that have been reported. It was originally published on March 17, 2023.