Two dogs treated at a New Jersey veterinary hospital last year tested positive for a rare, drug-resistant strain of bacteria. This strain, linked to a fatal outbreak in humans caused by now-recalled eye drops, was identified by a CDC investigator.
The bacteria, known as carbapenemase-producing carbapenem-resistant Pseudomonas aeruginosa, was found in swabs from the lungs and ears of the two dogs, each from different owners. Genetic testing revealed that the bacteria in the dogs were “highly genetically related” to the strain responsible for an outbreak from recalled over-the-counter artificial tears. This human outbreak sickened 81 patients across 18 states, resulting in 14 cases of vision loss and four fatalities.
Health Officials’ Concerns
Health officials are particularly worried about bacteria that produce carbapenemase because these bacteria can break down carbapenem antibiotics, which are typically reserved for treating infections resistant to other antibiotics. Additionally, these bacteria can easily spread their resistance genes to other pathogens.
Human Outbreak and FDA Crackdown
The 2023 human eye drops outbreak prompted the FDA to crack down on over-the-counter products, leading to the recall of millions of eye drops from reputable brands like CVS, Leader, Rugby, Rite Aid, Target, Walmart, and Velocity.
FDA Warnings to Veterinary Hospitals
Following a report of an infection in a cat, the FDA issued a warning to veterinary hospitals and pet owners to check their supplies for recalled eye drops. Although the cat’s infection couldn’t be conclusively linked to the eye drops, the warning emphasized the potential risk.
Investigation of Pet Owners
Interviews with the owners of the infected dogs did not reveal any obvious sources of the drug-resistant germs. Neither owner had traveled internationally or visited human hospitals, nor did they recall using the contaminated eye drops. However, recalling past events accurately can be challenging.
The Eye Drop Recall
In early 2023, the FDA requested manufacturers to voluntarily submit and recall their products. EzriCare Artificial Tears and Delsam Pharma Artificial Tears, produced by Global Pharma Healthcare Private LTD, complied, initiating their recalls on February 2 and February 24, 2023. However, other manufacturers refused to voluntarily recall their products.
On August 30, 2023, the FDA mandated the recall of 28 brands, including CVS, Leader, Rugby, Rite Aid, Target, Walmart, and Velocity, due to their refusal or failure to voluntarily recall their products.
Companies Cleared of Contamination
The following companies, which voluntarily recalled their products manufactured by Global Pharma Healthcare Private LTD, have been cleared of any contamination issues:
- EzriCare Artificial Tears Lubricant Eye Drops
- Delsam Pharma Artificial Tears
- Delsam Pharma Artificial Eye Ointment
Testing conducted by the FDA on unopened bottles of EzriCare Artificial Tears produced by Global Pharma Healthcare Ltd. did not identify any outbreak strain. The VIM-GES-CRPA outbreak cluster was found to be at least 32 SNPs distant from Indian contextual isolates, indicating that the contaminants could not have evolved from the isolate components used by Global Pharma.