Multidrug-Resistant Pseudomonas aeruginosa Keratitis Associated With Artificial Tear Use

Abstract

This case report describes severe multidrug-resistant Pseudomonas aeruginosa keratitis in a 72-year-old man after EzriCare artificial tear use.

Association of Serious Adverse Effects With the Contamination of Ocular Medications—A Global Perspective

“…This case report by Shoji et al also demonstrates the importance of microbial culture and antibiogram in the diagnosis and treatment of corneal ulcer, especially bacterial keratitis. A high degree of suspicion is required to identify secondary bacterial contamination and multidrug resistance in nonhealing infectious keratitis.…”

“…Recently, Shoji and coauthors discussed a case of corneal ulcer caused by multidrug-resistant (MDR) Pseudomonas aeruginosa after the use of artificial tears. This is a wake-up call to the worldwide ophthalmic community about the importance of adhering to standard operating protocols in the manufacture of these medications, as artificial tears are available without prescription around the world.…”

Cefiderocol is an effective topical monotherapy for experimental extensively-drug resistantPseudomonas aeruginosakeratitis

“…The Center for Disease Control and Prevention (CDC) and numerous news organizations recently reported a dangerous outbreak of eye infections linked to the use of artificial tears purchased online [1][2][3][4] . Patients identified in this outbreak have experienced serious corneal infections which have led to blindness, loss of eyes, and even death in several patients.…”

“…Notably, the Pseudomonas aeruginosa bacteria causing the infections was extensively drug resistant (XDR) including to all antibiotics currently used to topically treat eye infections 2,3 . This strain has the Verona integron-mediated metallo-β-lactamase and Guiana extended-spectrum β -lactamase genes 1,4,5 .…”

Reimagining the Past: A Future for Antibiotic Drug Discovery in Ophthalmology

“…14 While, in general, rates of antibiotic resistance among ocular P. aeruginosa strains remain low in the United States, 14,15 fluoroquinolone resistance rates as high as 50% have been reported in India, 16,17 and the devastating 2023 outbreak of extensively drug-resistant P. aeruginosa associated with artificial tears is a powerful reminder of how these resistant pathogens can evade current therapies. 18 Importantly, despite these worrisome trends, the arsenal of commercially available ophthalmic antibiotics has remained static because skyrocketing costs and limited returns on investment have led most pharmaceutical companies to abandon antibiotic drug discovery. 6 As such, there have been no new ophthalmic antibiotics entering the commercial market in over a decade.…”