Two Cases of Maggot-Associated Bacteremia in Xylazine-Induced Injection Wounds: An Emerging Threat.

The city of Philadelphia has seen an increase in homelessness and substance use disorders, often associated with xylazine-contaminated opiates. Here, we report the first two cases of wound infection and bacteremia associated with the Gram-negative rod species. Both cases were associated with maggot colonization in chronic lower extremity wounds from fentanyl/xylazine injections. Poor living conditions and lack of wound care are central to both case presentations. We believe this organism to be an emerging medical threat associated with injection drug use, xylazine-associated wounds, and homelessness which may impact future treatment options in this patient population. This report underscores the emergence of bacteremia in individuals with a history of xylazine-associated wounds and substance use disorder. Successful management should prioritize wound care and adherence to antibiotic regimens to prevent complications in these challenging cases.