CSTE Letter of Support/Invitation

December 19, 2022

Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30329
Dear CDC:
I am writing in regard to a multistate outbreak of verona integron metallo-β-lactamase (VIM)-producing
carbapenem-resistant Pseudomonas aeruginosa (VIM-CRPA). From May 1, 2022-December 15, 2022, 48
confirmed isolates from 41 patients in 10 different states have been identified. All isolates were ST1203
with VIM-80 and GES-9 carbapenemase genes (a combination not previously seen in the U.S.), and
closely related based on whole genome sequencing analysis. Case-patients have been identified in a
variety of healthcare settings including 4 facility clusters (1 eye clinic, 3 LTACHs) and there are no known
epidemiological links between patients from different states. There is concern these cases might be
linked to a contaminated medical product and as such this ongoing outbreak represents an urgent
threat to public health. Thus, the investigation of this outbreak will necessitate a coordinated multi-state
and jurisdictional investigation, as well as specialized assistance and resources to adequately respond.
The Council of State and Territorial Epidemiologists (CSTE) strongly supports a centrally coordinated
multistate and jurisdictional investigation of VIM-CRPA and recommends multistate technical
assistance from the Centers for Disease Control and Prevention (CDC).
A multistate coordinated investigation of VIM-CRPA will assist each state/local/territory jurisdiction in
making rapid, practical decisions for actions to prevent and control the public health problem including
support for obtaining and sharing lists of products received by case-patients which could be serving as
the source. This approach will streamline and strengthen the response, as opposed to multiple state and
jurisdictional investigations independently addressing VIM-CRPA monitoring and risk assessment.
Each jurisdiction participating in the multi-jurisdictional response would retain ownership of and is
responsible for all data collected within their state.
Sincerely,

Janet Hamilton, MPH
Executive Director
Council of State and Territorial Epidemiologists