Extensively Drug-Resistant Pseudomonas aeruginosa Outbreak Associated With Artificial Tears
Marissa K Grossman1,2, Danielle A Rankin1, Meghan Maloney3
1Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Background:
Carbapenemase-producing, carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) are extensively drug-resistant bacteria. We investigated the source of a multistate CP-CRPA outbreak.
Methods:
Cases were defined as a US patient's first isolation of P. aeruginosa sequence type 1203 with carbapenemase gene blaVIM-80 and cephalosporinase gene blaGES-9 from any specimen source collected and reported to the Centers for Disease Control and Prevention during 1 January 2022-15 May 2023. We conducted a 1:1 matched case-control study at the post-acute care facility with the most cases, assessed exposures associated with case status for all case-patients, and tested products for bacterial contamination.
Results:
We identified 81 case-patients from 18 states, 27 of whom were identified through surveillance cultures. Four (7%) of 54 case-patients with clinical cultures died within 30 days of culture collection, and 4 (22%) of 18 with eye infections underwent enucleation. In the case-control study, case-patients had increased odds of receiving artificial tears versus controls (crude matched OR, 5.0; 95% CI, 1.1-22.8). Overall, artificial tears use was reported by 61 (87%) of 70 case-patients with information; 43 (77%) of 56 case-patients with brand information reported use of Brand A, an imported, preservative-free, over-the-counter (OTC) product. Bacteria isolated from opened and unopened bottles of Brand A were genetically related to patient isolates. Food and Drug Administration inspection of the manufacturing plant identified likely sources of contamination.
Conclusions:
A manufactured medical product serving as the vehicle for carbapenemase-producing organisms is unprecedented in the United States. The clinical impacts from this outbreak underscore the need for improved requirements for US OTC product importers.
Insights
An outbreak of drug-resistant Pseudomonas aeruginosa was linked to contaminated artificial tears. This highlights the need for better oversight of imported over-the-counter medical products in the U.S.
Area of Science:
- Microbiology
- Epidemiology
- Public Health
Background:
- Carbapenemase-producing, carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) are extensively drug-resistant bacteria posing a significant public health threat.
- Investigated the source of a multistate CP-CRPA outbreak to understand transmission dynamics.
Purpose of the Study:
- To identify the source of a multistate outbreak of carbapenemase-producing, carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA).
- To assess risk factors associated with infection and identify contaminated products.
Main Methods:
- Conducted a 1:1 matched case-control study at a post-acute care facility.
- Defined cases based on isolation of specific P. aeruginosa sequence type and resistance genes.
- Tested products, including artificial tears, for bacterial contamination.
Main Results:
- Identified 81 case-patients across 18 states, with severe outcomes including death and enucleation.
- Case-patients showed increased odds of using artificial tears (OR, 5.0).
- Contaminated Brand A artificial tears, an imported over-the-counter product, were genetically linked to patient isolates.
Conclusions:
- A manufactured medical product, specifically artificial tears, served as the vehicle for carbapenemase-producing organisms, which is unprecedented in the U.S.
- The clinical impact underscores the need for enhanced regulatory requirements for imported over-the-counter medical products.
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