A concerning eye infection caused by EzriCare eye drops emerged months before the CDC issued a warning on May 16, 2023. In February, the Centers for Disease Control and Prevention cautioned against using EzriCare eye drops due to their connection to drug-resistant bacterial infections that could lead to vision loss and fatalities. However, it appears that tainted bottles of the product may have been causing issues long before the official warning.
A recent study published in Antimicrobial Agents and Chemotherapy by a group of researchers and physicians from Cleveland, Ohio, describes a case from November 2022. The patient, a 72-year-old female, was diagnosed with a corneal ulcer resulting from an infection caused by the bacterium Pseudomonas aeruginosa. After a thorough investigation, infectious disease physicians and microbiologists determined that her contaminated eye drops were the source of the infection.
Pseudomonas aeruginosa is a gram-negative bacterium that is pathogenic and resistant to most antibiotics. While it commonly causes swimmer’s ear and other serious conditions, especially in individuals with weakened immune systems, the case in Cleveland was unusual, as highlighted by Morgan Morelli, MD, the study’s first author and an infectious disease fellow at the hospital.
In a news release, Morelli stated, “I’ve never recovered it from an eye.” The presence of Pseudomonas aeruginosa in eye infections is atypical, making the correct diagnosis a challenging task. Morelli explained, “It required a lot of thinking and digging to figure out what was going on. And we never thought it was related to a global manufacturing issue.”
The patient initially sought help at an outpatient eye clinic after experiencing blurry vision. Subsequently, she was referred to the emergency department at the hospital, where ophthalmologists evaluated her condition. They conducted a culture of the infection, prescribed potent antibiotic eye drops, and sent her home. However, the following day, her eye worsened, prompting her to visit a cornea specialist.
In addition, the woman had observed a yellow discharge on her pillow, and there was no history of swimming, as noted in the study. Morelli expressed, “We wondered if she’d accidentally touched something or there was some freak accident,” in an attempt to explain the infection.
At this point, the case was handed over to microbiologists and infectious disease experts at the hospital. Scott Fulton, MD, an infectious disease specialist, requested the patient’s husband bring in her eye drops for testing. A sample from the patient was sent to the lab of Robert Bonomo, MD, an expert in gram-negative, drug-resistant bacteria at Case Western Reserve University School of Medicine.
As the investigation progressed, the pieces of the puzzle began to fit together. Bonomo’s lab identified a Pseudomonas aeruginosa isolate that matched the genetic material found in the EzriCare artificial tear eye drops the patient had been using. The researchers established a connection between the eye infection and the ulcer it had caused with the contaminated drops.
Treating the patient proved to be challenging, as the isolate was resistant to antibiotics that could be administered directly to the eye. Physicians opted for a strong antibiotic, cefiderocol, which exhibits some activity against gram-negative bacteria, along with two other topical antibiotics.
According to Morelli, the patient’s eye condition started to improve, but it remains uncertain whether she will fully regain her vision in that eye, as stated in the news release.
Since issuing the warning in February, the CDC has identified infectious cases linked to Pseudomonas aeruginosa as early as spring 2022. Morelli commented, “I think it took a while for this to be put together, in terms of what all these patients had in common.” Although the contaminated product has been removed from stores and can no longer be purchased, there may still be a risk associated with the presence of EzriCare eye drops in people’s medicine cabinet shelves. Morelli also emphasized the importance of raising awareness among ophthalmologists and optometrists, as they may be the first healthcare professionals to encounter future patients with this infection. She hopes that they will be knowledgeable about the symptoms and history associated with this particular eye infection, urging them to inquire about over-the-counter medicines used by their patients.
“We don’t always get this detailed of a history or ask someone to bring in over-the-counter medicine they’re using,” Morelli concluded. “We really wanted to raise awareness.” By remaining vigilant and informed, healthcare providers and individuals can contribute to preventing further cases and potential complications related to contaminated eye drops.
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