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CDC advises immediate discontinuation of EzriCare Artificial Tears

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The Centers for Disease Control and Prevention (CDC) has issued a statement calling for the immediate discontinuation of the use of EzriCare Artificial Tears for dry eye treatment following reported infections across the country.

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The CDC stated that it is currently investigating a cluster in multiple states of Verona Integron‐mediated Metallo‐β‐lactamase (VIM)‐ and Guiana‐Extended Spectrum‐β‐Lactamase (GES)‐ producing carbapenem‐resistant Pseudomonas aeruginosa (VIM‐GES‐CRPA) that are linked to various infection sites (inclusive of ocular tissues). (via)

When, where, and how were they identified?

VIM‐GES‐CRPA was reported in 50 patient cases (with 56 isolates), identified from May 17, 2022 to January 19, 2023, in 11 states: California, Colorado, Connecticut, Florida, New Jersey, New York, New Mexico, Nevada, Texas, Utah, and Washington. Of the 50 cases, 38 were part of four facility clusters.

Isolates were identified from clinical cultures of several specimens collected, including of the cornea, urine, blood, and rectal swabs.

Why EzriCare Artificial Tears?

The company’s artificial tears (carboxymethylcellulose sodium 10 mg) are preservative-free, over-the-counter (OTC), and dispensed in multi-dose bottles.

According to the CDC, review of common exposures among patients determined that the majority of patients had used artificial tears prior to infection, with EzriCare Artificial Tears being the most common brand reported.  

Laboratory testing found an initial presence of VIM-CRPA in opened bottles of the tears; further analysis is being done to identify a potential match to the outbreak strain. (via)

What symptoms did patients report?

The CDC reported permanent vision loss as a result of ocular infection, hospitalization, as well as the death of one patient (from a bloodborne infection).

So what is the CDC recommending?

Any clinicians and patients should stop use of the EzriCare Artificial Tears until laboratory analyses and epidemiological studies are completed,

For any laboratories that identify VIM-CRPA or carbapenem‐resistant P. aeruginosa from an ocular specimen, they should send the isolate to the Antimicrobial Resistance Laboratory Network for further characterization.