Eight people lost their sight, three died: what you need to know about bacteria-infected eye drops in the US

An outbreak of a strain of drug-resistant bacteria associated with recalled eye drops is fraught with three deaths and other serious injuries, according to the US Centers for Disease Control and Prevention (CDC). Writes about it USA Today

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In recent months, the CDC and the US Food and Drug Administration (FDA) have warned patients and clinicians to stop using EzriCare or Delsam Pharma Artificial Tears products.

Products manufactured by Global Pharma Healthcare based in India have been withdrawn in February due to potential bacterial contaminationassociated with a multi-state outbreak of the Pseudomonas aeruginosa strain (Pseudomonas aeruginosa) with extensive drug resistance.

In addition to the three deaths, as of March 14, the outbreak investigation confirmed 8 reports of loss of vision and 4 cases of surgical removal of eyeballs.

Users of eye drops that are not subject to the recall may feel safe to continue using their products, health care providers say.

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“Due to the recent recall, only users of specific recalled brands should be concerned,” said Dr. Christopher Starr, spokesman for the American Academy of Ophthalmology.

“Before administering eye drops, everyone should double check the bottle label to make sure it is not one of the recalled products. But at this time, there are no concerns about using other eye drops,” Starr said.

Death and loss of vision

The CDC said the outbreak of drug-resistant Pseudomonas aeruginosa associated with recalled products such as Artificial Tears EzriCare and Delsam Pharma has reached 16 states. As of March 14, 68 patients have been identified, with more than half of them associated with four clusters of healthcare facilities, according to the CDC.

Several types of infections are associated with the outbreak, including eye infections. Three people have died and eight have reported loss of vision. In addition, there were four cases of enucleation, a procedure in which the eyeball is surgically removed.

“The majority of patients reported using Artificial Tears,” the CDC wrote, noting that more than 10 different brands of Artificial Tears are involved. According to the CDC, Artificial Tears from EzriCare appeared most often.

All recalled products were sold under two brand names: EzriCare Artificial Tears Lubricant Eye Drops and Delsam Pharma Artificial Tears Lubricant Eye Drops. The boxes in which the products are shipped are marked with the following codes:

  • For Ezricare: NDC 79503-0101-15 and UPC 3 79503 10115 7
  • For Delsam Pharma: NDC 72570-121-15 and UPC 3 72570 12115 8
  • All products named Delsam Pharma Artificial Eye Ointment (NDC 72570-122-35, UPC 3 72570 12235 3).

EzriCare eye drops do not contain preservatives. Bottles of preservative-free eye drops tend to have a higher risk of infection, said Starr and Dr. Daniel Laroche, president of Advanced Eyecare in New York and clinical assistant professor of ophthalmology at the Icahn School of Medicine.

“Without antimicrobial preservatives, bacteria and fungi can multiply, potentially leading to eye-threatening infections,” Starr said. “But because traditional preservatives at high doses (eg, more than 4 drops per day) can cause eye surface irritation, we generally recommend preservative-free drops in disposable containers for most people.”

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The drug-resistant bacterial strain found in this outbreak is officially referred to as "Carbapenem-resistant Pseudomonas aeruginosa with integron-mediated Verona metallo-β-lactamase and Guiana extended-spectrum β-lactamase", or VIM-GES-CRPA.

VIM-GES-CRPA is very rare. The CDC writes that the strain was "never reported in the United States prior to this outbreak."

What is Pseudomonas aeruginosa

Pseudomonas is a bacterium that can be found in the environment, including water and soil. According to the CDC, there are several types of Pseudomonas. Pseudomonas aeruginosa causes most infections in humans.

Pseudomonas aeruginosa is transmitted to humans through contaminated surfaces, equipment, water, and more. The bacteria can cause infections in the lungs, blood, and other parts of the body.

Pseudomonas aeruginosa "is a very dangerous bacterium because it can spread quite quickly through the eye to the cornea and into the bloodstream," Laroche explained.

Infections are especially difficult to treat because Pseudomonas aeruginosa is constantly finding new ways to avoid the effects of antibiotics.

Tens of thousands of Pseudomonas aeruginosa infections have been reported in hospitalized patients in recent years, according to the CDC. People with weakened immune systems are especially at risk.

Safety of eye drops

Again, people with non-recall eye drops should feel safe continuing to use their products as usual. But there are additional steps that eye drop users can take to stay safe in their daily lives.

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“As a general rule, it is recommended not to use expired eye drops and to keep vial tips clean and free of contamination,” Starr said. “Always keep the cap on the bottle and keep it in a clean place.”

Other safety tips that Starr and Laroche recommend:

  • when instilling eye drops, do not allow the tip of the vial to touch the eyes, eyelashes or eyelids;
  • if you think the tip of the bottle is dirty, throw it away;
  • if the tip of the bottle is damaged and you do not want to throw it away, wipe the bottle with an anti-infective agent and let it air dry;
  • use eye drops within one month of opening them;
  • do not use the same eye drops for more than one person;
  • wash your hands before and after instilling eye drops;
  • always check the label to make sure your eye drops do not respond.

“If you have a red eye or blurred vision, seek immediate medical attention,” Larkosh cautioned. “The sooner you start treatment, the sooner you can prevent a more serious complication.”

Similar rules apply to contact lens solutions, Starr said. Do not "reuse and top up" the solution, as this can increase the risk of infection.

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