Extensively Drug-Resistant Pseudomonas aeruginosa Outbreak associated with Artificial Tears

Details

• Alternative Title:
  Clin Infect Dis
• Personal Author:
  Grossman, Marissa K. ; Rankin, Danielle A. ; Maloney, Meghan ; Stanton, Richard A. ; Gable, Paige ; Stevens, Valerie A. ; Ewing, Thomas ; Saunders, Katharine ; Kogut, Sarah ; Nazarian, Elizabeth ; Bhaurla, Sandeep ; Mephors, Jehan ; Mongillo, Joshua ; Stonehocker, Susan ; Prignano, Jeanette ; Valencia, Nickolas ; Charles, Argentina ; McNamara, Kiara ; Fritsch, William A. ; Ruelle, Shannon ; Plucinski, Carrie Ann ; Sosa, Lynn ; Ostrowsky, Belinda ; Ham, D. Cal ; Walters, Maroya S.
• Corporate Authors:
  Multistate Pseudomonas Outbreak Investigation Group
• Description:
  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 U.S. patient’s first isolation of P. aeruginosa sequence type 1203 with the carbapenemase gene blaVIM-80 and cephalosporinase gene blaGES-9 from any specimen source collected and reported to CDC between January 1, 2022–May 15, 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 four (22%) of 18 with eye infections underwent enucleation. In the case-control study, case-patients had increased odds of receiving artificial tears compared to 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. FDA 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 U.S. The clinical impacts from this outbreak underscore the need for improved requirements for U.S. OTC product importers.
  
  
• Subjects:
  Adult Aged Aged, 80 And Over Anti-Bacterial Agents Bacterial Proteins Beta-Lactamases Carbapenems Case-Control Studies Cephalosporinase Disease Outbreaks Drug Resistance, Multiple, Bacterial Female Humans Male Microbial Sensitivity Tests Middle Aged Pseudomonas Aeruginosa Pseudomonas Infections United States Young Adult

  More +
• Source:
  Clin Infect Dis. 79(1):6-14
• Pubmed ID:
  38315890
• Pubmed Central ID:
  PMC11259536
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/ ; Centers for Disease Control and Prevention (CDC)/
• Volume:
  79
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:12560a307c03bbfb001fcb6254c3c5d5f670087d27ca890764c42a58d1126e1c024aa57f5e69f75d159cd514baec4d41e30e0a26660e11388609259e38b5b3e3
• Download URL:
  https://stacks.cdc.gov/view/cdc/159323/cdc_159323_DS1.pdf
• File Type:
  [PDF - 996.57 KB ]