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Immunocompromised patients should not be treated with some eye gels owing to bacterial contamination, a national patient safety alert has warned.
The alert, issued by the UK Health Security Agency (UKHSA) on 7 December 2023, said burkholderia cenocepacia, a bacterium that can cause severe infection and death in some patients, has been detected in some carbomer-containing eye products.
It said that, “as a precautionary measure”, patients, including those who are severely immunocomprised or are being treated in critical care settings, should not be treated with carbomer-containing lubricating eye products.
A safety notice was issued on 24 November 2023 by manufacturer Indiana Opthalmics, recalling batches of three of its carbomer-containing lubricating eye gels (Aacarb, Aacomer and Puroptics) because of fears of contamination.
In the patient safety alert, the UKHSA said it had recovered burkholderia cenocepacia from a “small number of carbomer-containing eye products including, but not exclusively, from recalled products”.
It added: “There are currently 32 confirmed cases in England and Scotland, identified from 16 hospitals and the community. Specimen dates are between January and November 2023 (majority October to November 2023). Twenty-three of 32 (72%) were critical care inpatients, 2 (6%) had cystic fibrosis, and 3 (9%) were children aged under 3 months.”
The alert warns: “Burkholderia cenocepacia is a species of the Burkholderia cepacia complex (Bcc) found in natural environments.
“Bcc are opportunistic pathogens, rarely causing infection in healthy individuals but can cause severe infections in some groups, including those with cystic fibrosis, immunocompromised, and critical care inpatients.
“As a precautionary measure, while further testing is conducted, avoid use of all carbomer-containing lubricating eye products for patients in the following groups: individuals with cystic fibrosis; patients being cared for in critical care settings; severely immunocompromised; patients awaiting lung transplantation.”
Alternatives to carbomer-containing lubricating eye gels are available.
