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Clinical Microbiology in Xylazine-Associated Wound Infections.

Deanna M Berg1, Amanda Binkley1, Sean D Foster2

  • 1Department of Pharmacy Services, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA.

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Xylazine-associated wound infections in injection drug users are often caused by Staphylococcus aureus and Streptococcus. Antimicrobial therapy should target these common pathogens, with consideration for gram-negative coverage in severe bone and joint infections.

Keywords:
MRSAantibioticsantimicrobial stewardshipantimicrobialsbone and joint infections

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Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Public Health

Background:

  • Injection drug use (IDU) involving xylazine is linked to chronic necrotic wounds.
  • The etiology of these wounds is not always infectious.
  • Understanding the microbiology is crucial for effective treatment.

Purpose of the Study:

  • To describe the clinical microbiology of xylazine-associated wound infections.
  • To guide antimicrobial prescribing for these infections.

Main Methods:

  • Retrospective cohort study of hospitalized adults with xylazine-associated wound infections from IDU.
  • Inclusion criteria: antimicrobial treatment for suspected wound infection, positive urine xylazine or reported xylazine use with positive fentanyl test.
  • Collection of wound and blood culture data, antimicrobial spectrum, and hospital outcomes.

Main Results:

  • 166 patients included; 56% had positive cultures (wound and blood).
  • Predominant pathogens: methicillin-resistant Staphylococcus aureus (MRSA) and β-hemolytic streptococci.
  • Pseudomonas aeruginosa identified in 8 wound cultures, primarily with bone and joint infections.

Conclusions:

  • Empiric antimicrobial coverage for xylazine-associated wound infections must include MRSA and β-hemolytic streptococci.
  • Consider gram-negative and anaerobic coverage for suspected bone and joint infections.