Multidisciplinary Guidance to Care for Persons With Xylazine-Associated Wounds

Area of Science:

• Public Health
• Infectious Diseases
• Dermatology

Background:

• Xylazine is an increasingly prevalent adulterant in unregulated opioid supplies in the United States.
• Xylazine-associated wounds (XAWs) present distinct clinical challenges, often chronic and prone to superinfection.
• These wounds are typically found on extremities and not exclusively linked to injection drug use.

Purpose of the Study:

• To provide multidisciplinary guidance for the clinical care of patients with Xylazine-associated wounds (XAWs).
• To outline essential components of treatment, including substance use disorder management and specialized medical interventions.

Main Methods:

• Multidisciplinary expert consensus and guidance development.
• Recommendations for wound care, including debridement and antibiotic selection.
• Strategies for managing chronic infections and patient discharge.

Main Results:

• Emphasizes the need for longitudinal, multidisciplinary care involving addiction medicine, wound care, infectious diseases, and surgery.
• Recommends against aggressive debridement of XAWs.
• Suggests empirical antibiotics for MRSA and GAS, with specific oral agents (trimethoprim-sulfamethoxazole for MRSA, beta-lactams for GAS).
• Proposes intravenous daptomycin to mitigate challenges of vancomycin therapeutic drug monitoring.
• Advocates for contingency antibiotic plans for discharge, including options like linezolid, tedizolid, or dalbavancin.

Conclusions:

• Comprehensive, multidisciplinary care is imperative for managing Xylazine-associated wounds.
• Specific antibiotic regimens and wound care approaches are recommended to address common infections and patient needs.
• Proactive planning for long-term management and discharge is essential for positive patient outcomes.