Berg Deanna M, Binkley Amanda, Foster Sean D, Hinton Matthew, Peiffer Derek, Huo Samantha C, Torgersen Jessie, Maguire Christina
Department of Pharmacy Services, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA.
Department of Emergency Medicine, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA.
Open Forum Infect Dis. 2025 Aug 7;12(8):ofaf384. doi: 10.1093/ofid/ofaf384. eCollection 2025 Aug.
Injection drug use (IDU) containing xylazine has been associated with the development of chronic necrotic wounds, albeit not all are of infectious etiology. This study describes the clinical microbiology of xylazine-associated wound infections to guide antimicrobial prescribing.
We conducted a retrospective, single-center cohort study of adults hospitalized with xylazine-associated wound infections related to IDU from 1 April 2022 to 1 December 2023. Patients were included if they received antimicrobials for suspected wound infections, along with either a positive urine xylazine test or urine fentanyl test with patient-reported xylazine use. Microbiology results of wound and blood cultures were collected. Antimicrobial spectrum and hospital outcomes were described, including multidrug-resistant organisms' isolation, duration of therapy, in-hospital mortality, and 30-day readmission.
A total of 166 patients were included, of whom 81 had wound cultures and 153 had blood cultures collected; more than half had positive cultures (93/166 [56.0%]). Most wound cultures were positive (78/81 [96.3%]), compared to 25.5% of blood cultures (39/153). Approximately 40% of wound cultures were obtained operatively. Gram-positive organisms were isolated in nearly all wound (73/78 [93.6%]) and blood (37/39 [94.9%]) cultures. The predominant causative organisms were methicillin-resistant (MRSA) (52/93 [55.9%]) and β-hemolytic streptococci (34/93 [36.6%]). was isolated in wound cultures of 8 patients, 7 with bone and joint infections.
Empiric antimicrobial coverage for suspected xylazine-associated wound infections should include MRSA and β-hemolytic streptococci coverage. Empiric gram-negative and anaerobic coverage may be warranted for those with higher suspicion of bone and joint involvement.
使用含有赛拉嗪的注射毒品（IDU）与慢性坏死性伤口的形成有关，尽管并非所有伤口都是感染性病因。本研究描述了赛拉嗪相关伤口感染的临床微生物学情况，以指导抗菌药物的处方。
我们对2022年4月1日至2023年12月1日因与IDU相关的赛拉嗪相关伤口感染而住院的成年人进行了一项回顾性单中心队列研究。如果患者因疑似伤口感染接受了抗菌药物治疗，同时尿液赛拉嗪检测呈阳性或尿液芬太尼检测呈阳性且患者报告使用了赛拉嗪，则纳入研究。收集伤口和血液培养的微生物学结果。描述了抗菌谱和医院结局，包括多重耐药菌的分离、治疗持续时间、住院死亡率和30天再入院率。
共纳入166例患者，其中81例进行了伤口培养，153例进行了血液培养；超过一半的培养结果为阳性（93/166 [56.0%]）。大多数伤口培养结果为阳性（78/81 [96.3%]），而血液培养结果为阳性的比例为25.5%（39/153）。约40%的伤口培养是在手术中获得的。几乎所有伤口（73/78 [93.6%]）和血液（37/39 [94.9%]）培养中都分离出革兰氏阳性菌。主要致病菌为耐甲氧西林金黄色葡萄球菌（MRSA）（52/93 [55.9%]）和β溶血性链球菌（34/93 [36.6%]）。8例患者的伤口培养中分离出[此处原文缺失一种细菌名称]，7例患有骨和关节感染。
对于疑似赛拉嗪相关伤口感染的经验性抗菌覆盖应包括对MRSA和β溶血性链球菌的覆盖。对于高度怀疑有骨和关节受累的患者，经验性革兰氏阴性菌和厌氧菌覆盖可能是必要的。
