The U.S. Centers for Disease Control and Prevention (CDC) are now urging health care providers and consumers to stop using EzriCare Artificial Tears as it conducts an investigation into what is says are at least 55 infections in 12 states that have led to instances of permanent vision loss, hospitalizations and one death.

Most of the people with infections reported using at least one of more than 10 brands of artificial tears, and the majority of these patients reported using EzeriCare’s products.

These eye drops are preservative-free, meaning they don’t have ingredients to prevent bacterial growth.

The CDC says it received reports of infections of the cornea, intraocular fluids, respiratory tract, and urinary tract, as well as sepsis.

Testing of EzriCares bottles identified Pseudomonas aeruginosa bacteria that are resistant to a broad array of antibiotics.

The antibiotics include: cefepime, ceftazidime, piperacillin-tazobactam, aztreonam, carbapenems, ceftazidime-avibactam, ceftolozane-tazobactam, fluoroquinolones, polymyxins, amikacin, gentamicin and tobramycin.

However, bacterial isolates that were tested against cefiderocol were susceptible to it.

The bacteria in the open bottles could have come from contamination either during use or during the manufacturing process, the CDC says. Testing of unopened bottles is still ongoing.

New Jersey-based EzriCare says in a statement that after learning about the investigation Jan. 20, it “immediately took action to stop any further distribution or sale of EzriCare Artificial Tears. To the greatest extent possible, we have been contacting customers to advise them against continued use of the product.”

The eye drops are made in India, and “we understand that the same product is also marketed under other brand names,” the company says. The manufacturer, Global Pharma Healthcare PVT Limited, is working with the U.S. Food and Drug Administration on a recall, EzriCare says.

The CDC urges health care providers to immediately stop using EzriCare Artificial Tears. They should advise their patients who use this product to watch for signs of infection and ask about product use in patients who have eye infections.

The CDC also advises consumers to stop using these EzriCare eye drops and to ask for alternative products if their health care provider recommended EzriCare.

Pseudomonas bacteria are common in the environment, such as in soil and water. Pseudomonas aeruginosais usually spread in health care settings, the CDC says, and is increasingly difficult to treat because of antibiotic resistance. It caused more than 32,000 infections in hospitalized patients and about 2,700 deaths in the U.S. in 2017.

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