In an update yesterday, the Centers for Disease Control and Prevention (CDC) said 68 patients in 16 states have been identified in the outbreak of a rare strain of extensively drug-resistant Pseudomonas aeruginosa linked to eye drops.

The outbreak, which was first reported by the CDC in January, involves a carbapenem-resistant P aeruginosa (CRPA) strain carrying the Verona integron-mediated metallo-beta-lactamase (VIM) and Guiana extended-spectrum beta-lactamase (GES) genes. Multiple types of infections, including eye infections, have been reported. Of the 68 patients identified by the CDC and state and local health departments as of March 14, 37 were linked to four healthcare facilities. Three patients have died, eight have experienced vision loss, and four have had an eye surgically removed.

Most patients reported using artificial tears, with EzriCare Artificial Tears the most commonly reported brand and the only one used in all four affected healthcare facilities. CDC testing identified the presence of VIM-GES-CRPA isolates in opened bottles from patients with and without infections in two states. CDC is advising the public and healthcare providers to stop using EzriCare and Delsam Pharma's Artificial Tears pending further investigation and guidance and is urging anyone who has used the products and has signs and symptoms of an eye infection to seek care immediately.

The VIM-GES-CRPA isolates are resistant to multiple antibiotics used to treat Pseudomonas infections, including carbapenems, ceftazidime, cefepime, piperacillin-tazobactam, aztreonam, and ceftazidime-avibactam. Prior to the outbreak, P aeruginosa strains carrying this combination of resistance genes had not been seen in the United States. The CDC considers multidrug-resistant P aeruginosa a serious threat.

Given the extensive drug resistance associated with VIM-GES-CRPA, the CDC said bacteriophages with activity against the strain have been identified as a potential treatment option by the University of California at San Diego's Center for Innovative Phage Applications and Therapeutics.

The growth hormone somatropin is in shortage, according to the American Society of Health-System Pharmacists (ASHP) and the US Food and Drug Administration (FDA). Resupply and recovery dates range from late this month to December.

Somatropin manufacturers Novo Nordisk, Eli Lilly, and Pfizer have all reported shortages.

Novo Nordisk's 15 milligram (mg)/1.5 milliliter (mL) Norditropin Flexpro pen injector has been only intermittently available, which the company says is due to increased demand and manufacturing delays, according to ASHP. The 10 mg/1.5 mL, 30 mg/3 mL, and 5 mg/1.5 mL formulations are still available, the site says, although the FDA's site lists all four presentations as in shortage.

Eli Lilly's Humatrope 12-mg and 24-mg kits have been in shortage since January due to delays at the contract manufacturer, and Eli Lilly's Humatrope has been unavailable since February for the same reason. Pfizer's 5 mg/mL and 12 mg/mL two-chamber cartridges and its Miniquick presentations are out of stock due to increased demand and other reasons, according to the company.

Genentech (Nutropin NuSpin) and Sandoz (Omnitrope) formulations are still available.

Somatropin is used to treat adults and children with a growth hormone deficiency and in children with some conditions that may slow or prevent normal growth and development.

In its latest global flu update, the World Health Organization (WHO) said activity continues to decline, though levels in parts of Europe are still above the epidemic threshold and with a spike in activity in China.

In Europe, half of the countries are still reporting widespread activity, though in North America, flu has declined to levels normally seen at this point of the season. The WHO report roughly covers the end of February and into the first week of March.

In East Asia, flu increased steeply in China, mainly due to the 2009 H1N1 virus, though other countries in the region reported declines. In South East Asia, activity remained elevated, led by influenza B in Malaysia and H3N2 in Singapore and Thailand. And in South Asia, flu levels remained low except in India, which is experiencing brisk H3N2 activity.

Of respiratory specimens that were positive for flu at national flu labs, 69.5% were influenza A, and 30.5% were influenza B. Of subtyped influenza A viruses, 74.5% were 2009 H1N1. Of influenza B viruses, all belonged to the Victoria lineage.

Wildlife officials in Texas yesterday announced the state's first H5N1 avian influenza detection in a mammal, a striped skunk found in Carson County, located just east of Amarillo. In a statement, Texas Parks & Wildlife said the findings were confirmed at the US Department of Agriculture (USDA) National Veterinary Services Laboratory in Ames, Iowa.

Skunks infected with H5N1 have been detected in several other states, along with other several other mammal species, including mountain lions, raccoons, bears, and bobcats.

In other US developments, the USDA's Animal and Plant Health Inspection Service (APHIS) reported one more outbreak in poultry, which occurred at a facility in Pennsylvania's Lancaster County that houses 500 birds. Also, APHIS reported 23 more H5N1 detections in wild birds, bringing the national total to 6,467. Many were raptors found dead in several states, but some were waterfowl that were positive in wild bird surveillance or testing in hunter-harvested birds.