Clinical and Demographic Characteristics of Hospitalized Patients With Xylazine-related Wounds

Little is known about the demographic and clinical features of patients with xylazine-related wounds. We sought to characterize hospitalized patients with substance use disorder (SUD) and xylazine-related wounds seen for infectious diseases consultation.

We retrospectively reviewed the medical records of 193 patients diagnosed with SUD at 3 Philadelphia hospitals between October 2023 and January 2024. Patients were identified as either being diagnosed with (n=73) or without (n=120) xylazine-related wounds. We compared the demographic and clinical features between the 2 groups.

Patients diagnosed with wounds were younger ( P <0.001), more likely to be White or Hispanic and less likely to be Black/AA ( P <0.001), more likely to have tested positive for fentanyl ( P <0.001), amphetamines ( P <0.001), and cocaine ( P 0.001), more likely to acknowledge injection ( P <0.001), and more likely to leave the hospital by patient-directed discharge (PDD) ( P <0.001). Most patients had multiple wounds (75%), and more than half (53%) had at least one wound greater than 10 cm at its widest dimension. Although most patients diagnosed with wounds received antibiotics, many did not have symptoms or signs of infection.

Xylazine-related wounds are highly associated with illicitly manufactured fentanyl (IMF) use and with drug injection in the city of Philadelphia. Many patients with xylazine-associated wounds do not have signs of infection and may not benefit from antibiotics. Understanding precisely how xylazine is responsible for wound development and how to best manage the wounds, including wound care and the role of antibiotics, is urgent.