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Clin Infect Dis ; 79(1): 6-14, 2024 Jul 19.
Article in English | MEDLINE | ID: mdl-38315890

ABSTRACT

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 US patient's first isolation of P. aeruginosa sequence type 1203 with carbapenemase gene blaVIM-80 and cephalosporinase gene blaGES-9 from any specimen source collected and reported to the Centers for Disease Control and Prevention during 1 January 2022-15 May 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 4 (22%) of 18 with eye infections underwent enucleation. In the case-control study, case-patients had increased odds of receiving artificial tears versus 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. Food and Drug Administration 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 United States. The clinical impacts from this outbreak underscore the need for improved requirements for US OTC product importers.


Subject(s)
Bacterial Proteins , Disease Outbreaks , Drug Resistance, Multiple, Bacterial , Pseudomonas Infections , Pseudomonas aeruginosa , beta-Lactamases , Humans , Pseudomonas aeruginosa/drug effects , Pseudomonas aeruginosa/genetics , Pseudomonas aeruginosa/isolation & purification , Pseudomonas Infections/epidemiology , Pseudomonas Infections/microbiology , Case-Control Studies , Male , Female , Middle Aged , Drug Resistance, Multiple, Bacterial/genetics , Aged , United States/epidemiology , Bacterial Proteins/genetics , beta-Lactamases/genetics , Adult , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Aged, 80 and over , Microbial Sensitivity Tests , Young Adult , Cephalosporinase/genetics , Cephalosporinase/metabolism , Carbapenems/pharmacology
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