Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 7;12(8):ofaf384.
doi: 10.1093/ofid/ofaf384. eCollection 2025 Aug.

Clinical Microbiology in Xylazine-Associated Wound Infections

Deanna M Berg  1 , Amanda Binkley  1 , Sean D Foster  2 , Matthew Hinton  1 , Derek Peiffer  1 , Samantha C Huo  2 , Jessie Torgersen  3   4 , Christina Maguire  1
Affiliations

Clinical Microbiology in Xylazine-Associated Wound Infections

Deanna M Berg et al. Open Forum Infect Dis. .

Abstract

Background: 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.

Methods: 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.

Results: 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 Staphylococcus aureus (MRSA) (52/93 [55.9%]) and β-hemolytic streptococci (34/93 [36.6%]). Pseudomonas aeruginosa was isolated in wound cultures of 8 patients, 7 with bone and joint infections.

Conclusions: 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.

Keywords: MRSA; antibiotics; antimicrobial stewardship; antimicrobials; bone and joint infections.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts.

Figures

Graphical Abstract
Graphical Abstract
This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/clinical-microbiology-in-xylazine-associated-wound-infections-907b4f6c-5e1a-420d-8ed5-b6676354fd3c?utm_campaign=tidbitlinkshare&utm_source=ITP
See this image and copyright information in PMC

References

    1. Armbrecht E, Guzauskas G, Hansen R, et al. Supervised injection facilities and other supervised consumption sites: effectiveness and value: final report. 2021. Available at: http://resource.nlm.nih.gov/9918230986806676. Accessed 18 August 2023.
    1. Krotulski AJ, Shinefeld J, DeBord J, Logan BK. Fentanyl purity, potency, and synthesis. 2022. Available at: https://www.drugsandalcohol.ie/36835/1/Fentanyl-Purity-Potency-and-Synth.... Accessed 10 April 2023.
    1. Philadelphia Department of Public Health, Division of Substance Use Prevention and Harm Reduction . Overdose deaths. 2022. Available at: https://www.substanceusephilly.com/fatal-overdoses. Accessed 20 August 2023.
    1. Carruthers SG, Nelson M, Wexler HR, Stiller CR. Xylazine hydrochloride (Rompun) overdose in man. Clin Toxicol 1979; 15:281–5. - PubMed
    1. Schmitt H, Fournadjiev G, Schmitt H. Central and peripheral effects of 2-(2,6-dimethylphenylamino)-4-H-5,6-dihydro-1,3-thiazin (Bayer 1470) on the sympathetic system. Eur J Pharmacol 1970; 10:230–8. - PubMed