How U.S. officials solved the mystery of eyedrops infecting dozens with drug-resistant bacteria

The patient’s eyes hurt. They can feel the light but can hardly see anything else. The doctor called it one of the worst cases of eye infection he had ever seen.

It was the start of a national outbreak caused by a highly feared bacteria — one that some say heralds an era when antibiotics no longer work and seemingly routine infections can’t be treated.

At last count, 58 Americans in 13 countries have been infected, including at least one death and at least five with permanent vision loss. All have been associated with broken eye drops, which have caused recall.

Experts are amazed at how the disease detectives put the case together: The patients are scattered all over the country. The disease occurs over several months. The infection is found in different parts of the body – in the blood of some patients, in the lungs of others.

But scientists are also shuddering, as they have long worried that common bacteria will evolve so that antibiotics will no longer work.

“This really shows that it’s not theoretical and in the future. It’s here,” said Dr. Luis Ostrosky, an infectious disease expert at the University of Texas Health Science Center in Houston.

This account is drawn from telephone and email interviews with US disease researchers, health officials in three countries and regulators in the US and India.

The investigation began in May in California

The investigation began in May in Los Angeles County, California. A patient who recently went to the eye doctor came in with a bad eye infection. A month later, local health officials got a second report. Another bad eye infection, same eye doctor.

Two more cases were reported in the county before the summer ended. The patient’s eyes were inflamed with heavy yellow pus that obscured most of the pupil. Among the four, two have lost complete vision in the affected eye.

The hospital that first reported the infection determined that it was caused by a so-called bacteria Pseudomonas aeruginosa.

The institute, which is equipped to carry out advanced genetic testing, quickly realized that the bacteria had a rare gene that protected it from the effects of commonly used antibiotics.

It’s an early break for investigators, said Kelsey OYong, of the Los Angeles County Department of Public Health.
OYong and his colleagues knew they were dealing with a scary germ, and they told the US Centers for Disease Control and Prevention (CDC).

Pseudomonas The infection is not new. Drug-resistant strains of the bacteria cause more than 30,000 infections each year among hospital patients in the U.S. and more than 2,500 deaths, the CDC says. It can spread through contaminated hands or medical equipment, and is especially dangerous for fragile patients who have catheters or are on breathing machines.

But the California infection was in the patient’s eyes, not the common spots like blood and lungs. In addition, laboratory analysis determines the infection caused by a Pseudomonas bacteria that can resist almost all antibiotics.

The only thing that works is a new antibiotic called cefiderocol, which is given by IV.

WATCH | Meet patients with drug resistance, and doctors looking for new treatments:

The long-term care epidemic in many countries

In summer, Pseudomonas outbreaks were seen in long-term care facilities in two other states.

In Connecticut, the first case was in June. Ultimately, the bacteria were found in 25 patients from five nursing homes in different states, said Christopher Boyle, a spokesman for Connecticut’s health department.

In Davis County, Utah, north of Salt Lake City, the first of six cases was reported to the CDC in August. When a patient has the bacteria, no one gets sick, said Sarah Willardson of the Davis County Health Department.

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But those suspicions disappeared in early October, when genetic tests showed clusters in California, Connecticut and Utah were all caused by the same strain of bacteria — a version of the germ that hadn’t been seen anywhere else.

“It made us think it was a product,” said Maroya Walters, the CDC official overseeing the investigation.

The Washington man died of a bloodstream infection

As the year goes on, more reports of drug resistance Pseudomonas in, including a Washington man who died of a blood infection.

Because of the initial cluster in a California ophthalmologist’s office, researchers suspect that eye care products are the cause, although that hypothesis is complicated by the fact that infections in long-term care facilities are primarily found in the lungs.

But it is not impossible. The tear duct drains into the nasal cavity, which leads to the lungs and may provide a pathway into the body.

In early November, researchers determined most of the infected Connecticut patients had been given artificial tears, although it was unclear who was given which brand.

Then, on November 9, a Florida hospital contacted the CDC to report a nasty eye infection linked to an outpatient clinic.

An examination of the brands of artificial tears used in Connecticut, Florida and Utah revealed one common product: EzriCare Artificial Tears, an over-the-counter product marketed in the US by New Jersey-based EzriCare LLC and manufactured in India by Global Pharma Healthcare.

WATCH | Antibiotic resistance increases:

Pseudomonas bacteria ‘everywhere’ in India

At Pseudomonas The bacteria are “pretty much everywhere” in India and drug-resistant germs are common in many hospitals, Dr. Gagandeep Kang, who studies microbes at the Christian Medical College in the same country as the Global Pharma factory.

In January, genetic sequencing confirmed the Florida case was caused by the same strain of bacteria as those in California, Connecticut and Utah. On January 20, the CDC urged doctors not to recommend EzriCare products.

There are no recalls or public notices circulating. Investigators had strong circumstantial evidence pointing to EzriCare drops, but didn’t get clearer evidence until more than a week after tests found the bacteria in seven bottles of EzriCare Artificial Tears in Connecticut and New Jersey.

In early February, CDC officials issued a public health alert and the FDA recalled EzriCare eye drops and Delsam Pharma’s Artificial Tears, another product made by Global Pharma. Last week, the recall was expanded to include Delsam Pharma Artificial Eye Ointment.

Global Pharma did not respond to an emailed request for comment.

Ostrosky, the University of Texas expert, called the US investigation a “public health victory,” saying it showed that fighting drug-resistant bacteria requires international collaboration and investment. But he also said the case was not very exciting.

Like many other drug-resistant pathogens, this infection that used to be easy to treat with common antibiotic eye drops “has become a deadly infection with no treatment other than IV antibiotics,” he said.