{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:06:46Z","timestamp":1785402406673,"version":"3.56.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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\u2019 isolation, duration of therapy, in-hospital mortality, and 30-day readmission.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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 \u03b2-hemolytic streptococci (34\/93 [36.6%]). Pseudomonas aeruginosa was isolated in wound cultures of 8 patients, 7 with bone and joint infections.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Empiric antimicrobial coverage for suspected xylazine-associated wound infections should include MRSA and \u03b2-hemolytic streptococci coverage. Empiric gram-negative and anaerobic coverage may be warranted for those with higher suspicion of bone and joint involvement.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofaf384","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T19:29:04Z","timestamp":1755026944000},"source":"Crossref","is-referenced-by-count":2,"title":["Clinical Microbiology in Xylazine-Associated Wound Infections"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4524-0222","authenticated-orcid":false,"given":"Deanna M","family":"Berg","sequence":"first","affiliation":[{"name":"Department of Pharmacy Services, Penn Presbyterian Medical Center , Philadelphia, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0273-0176","authenticated-orcid":false,"given":"Amanda","family":"Binkley","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services, Penn Presbyterian Medical Center , Philadelphia, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean D","family":"Foster","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Penn Presbyterian Medical Center , Philadelphia, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Hinton","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services, Penn Presbyterian Medical Center , Philadelphia, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek","family":"Peiffer","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services, Penn Presbyterian Medical Center , Philadelphia, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha C","family":"Huo","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Penn Presbyterian Medical Center , Philadelphia, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessie","family":"Torgersen","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania ,","place":["USA"]},{"name":"Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5590-2736","authenticated-orcid":false,"given":"Christina","family":"Maguire","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services, Penn Presbyterian Medical Center , Philadelphia, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,8,7]]},"reference":[{"key":"2025081215285768000_ofaf384-B1","author":"Armbrecht"},{"key":"2025081215285768000_ofaf384-B2","author":"Krotulski"},{"key":"2025081215285768000_ofaf384-B3","author":"Philadelphia Department of Public Health, Division of Substance Use Prevention and Harm Reduction"},{"key":"2025081215285768000_ofaf384-B4","doi-asserted-by":"crossref","first-page":"281","DOI":"10.3109\/15563657908989878","article-title":"Xylazine hydrochloride (Rompun) overdose in man","volume":"15","author":"Carruthers","year":"1979","journal-title":"Clin Toxicol"},{"key":"2025081215285768000_ofaf384-B5","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/0014-2999(70)90277-3","article-title":"Central and peripheral effects of 2-(2,6-dimethylphenylamino)-4-H-5,6-dihydro-1,3-thiazin (Bayer 1470) on the sympathetic system","volume":"10","author":"Schmitt","year":"1970","journal-title":"Eur J Pharmacol"},{"key":"2025081215285768000_ofaf384-B6","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.annemergmed.2024.01.041","article-title":"National Institute on Drug Abuse clinical trials network meeting report: managing patients exposed to xylazine-adulterated opioids in emergency, hospital and addiction care settings","volume":"84","author":"Perrone","year":"2024","journal-title":"Ann Emerg Med"},{"key":"2025081215285768000_ofaf384-B7","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/ADM.0000000000001245","article-title":"Xylazine-associated wounds: clinical experience from a low-barrier wound care clinic in Philadelphia","volume":"18","author":"McFadden","year":"2024","journal-title":"J Addict Med"},{"key":"2025081215285768000_ofaf384-B8","author":"Philadelphia Department of Public Health"},{"key":"2025081215285768000_ofaf384-B9","author":"Dunn"},{"key":"2025081215285768000_ofaf384-B10","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1093\/cid\/ciu296","article-title":"Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America","volume":"59","author":"Stevens","year":"2014","journal-title":"Clin Infect Dis"},{"key":"2025081215285768000_ofaf384-B11","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.idc.2020.06.007","article-title":"Soft tissue, bone, and joint infections in people who inject drugs","volume":"34","author":"Saldana","year":"2020","journal-title":"Infect Dis Clin North Am"},{"key":"2025081215285768000_ofaf384-B12","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.idc.2020.10.006","article-title":"Skin and soft tissue infections in persons who inject drugs","volume":"35","author":"Chambers","year":"2021","journal-title":"Infect Dis Clin North Am"},{"key":"2025081215285768000_ofaf384-B13","doi-asserted-by":"crossref","first-page":"e00925-21","DOI":"10.1128\/AAC.00925-21","article-title":"Incidence and predictors of gram-negative bacilli in hospitalized people who inject drugs with injection drug use\u2013attributable infections","volume":"65","author":"Kelly","year":"2021","journal-title":"Antimicrob Agents Chemother"},{"key":"2025081215285768000_ofaf384-B14","doi-asserted-by":"crossref","first-page":"625","DOI":"10.15585\/mmwr.mm6722a2","article-title":"Invasive methicillin-resistant Staphylococcus aureus infections among persons who inject drugs\u2014six sites, 2005\u20132016","volume":"67","author":"Jackson","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025081215285768000_ofaf384-B15","doi-asserted-by":"crossref","first-page":"ofae631.1650","DOI":"10.1093\/ofid\/ofae631.1650","article-title":"Staphylococcus aureus susceptibilities among patients who use illicit fentanyl in Philadelphia, Pennsylvania","volume":"12","author":"Dickinson","year":"2025","journal-title":"Open Forum Infect Dis"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/12\/8\/ofaf384\/63906404\/ofaf384.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/12\/8\/ofaf384\/63906404\/ofaf384.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T19:29:05Z","timestamp":1755026945000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofaf384\/8220670"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,31]]},"references-count":15,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,7,31]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofaf384","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,8]]},"published":{"date-parts":[[2025,7,31]]},"article-number":"ofaf384"}}