Warp Peyton V, Hauschild Maia, Tookes Hansel E, Ciraldo Katrina, Serota David P, Cruz Irasema
University of Miami Miller School of Medicine.
Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine.
Res Sq. 2023 Jul 26:rs.3.rs-3194876. doi: 10.21203/rs.3.rs-3194876/v1.
Xylazine is an alpha-2 adrenergic receptor agonist that has emerged as a contaminant in the street drug supply of fentanyl. Xylazine use may be suspected in naloxone-resistant overdoses and atypical, chronic wounds in people who inject drugs (PWID). This case is unique because it is the first case to our knowledge describing wound care for a xylazine-induced wound with a confirmatory xylazine test strip (XTS) in the setting of a syringe services program (SSP) and in the state of Florida.
A 43-year-old woman with a past medical history of severe opioid use disorder and stimulant use disorder presented to a student-run clinic at the IDEA Miami SSP for wound care. She had multiple ulcerations diffusely over her bilateral forearms with surrounding erythema and warmth. Seven weeks later, she presented to clinic again for wound care because her wounds had progressed. At this visit, a XTS was used to confirm the presence of xylazine in her urine. Wound care management and harm reduction strategies employed at both visits are discussed below. Wound outcomes are unknown as the patient has not returned to clinic.
Many PWID at highest risk for acute and chronic health consequences of xylazine-adulterated fentanyl do not have access to healthcare outside of low barrier clinics and SSPs due to lack of insurance or mistrust of the traditional healthcare system. There is an urgent need for access to XTS for PWID and clinical practice guidelines for the treatment of xylazine-related wounds in outpatient clinics.
赛拉嗪是一种α-2肾上腺素能受体激动剂，已成为街头芬太尼毒品供应中的一种污染物。在注射吸毒者（PWID）中，纳洛酮抵抗性过量用药和非典型慢性伤口可能提示使用了赛拉嗪。本病例独特之处在于，据我们所知，这是首例在注射器服务项目（SSP）背景下且在佛罗里达州，使用赛拉嗪检测试纸（XTS）确诊赛拉嗪导致的伤口并进行伤口护理的病例。
一名43岁女性，有严重阿片类药物使用障碍和兴奋剂使用障碍病史，前往迈阿密IDEA SSP的学生运营诊所寻求伤口护理。她双侧前臂广泛存在多处溃疡，周围有红斑和发热。七周后，她因伤口进展再次前往诊所寻求伤口护理。此次就诊时，使用XTS确认其尿液中存在赛拉嗪。下文将讨论两次就诊时采用的伤口护理管理和减少伤害策略。由于患者未再返回诊所，伤口预后情况未知。
许多因掺有赛拉嗪的芬太尼而面临急性和慢性健康后果高风险的注射吸毒者，由于缺乏保险或不信任传统医疗系统，无法在低门槛诊所和SSP之外获得医疗服务。迫切需要为注射吸毒者提供赛拉嗪检测试纸，并制定门诊诊所治疗赛拉嗪相关伤口的临床实践指南。
