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Increasing Polymicrobial Upper Extremity Infections with the Emergence of Xylazine
Etka Kurucan, MD
1; Eric Perez, BS
1; Elizabeth G Kogan, BA
2; Hesham M Abdelfattah, MD
2; Mark Solarz, MD
11Temple University Hospital, Philadelphia, PA; 2Lewis Katz School of Medicine at Temple University, Philadelphia, PA
INTRODUCTION
Xylazine is a non-opioid veterinary tranquilizer, and its use has been rapidly increasing in illicit drug supplies throughout the United States. It has been associated with increasing fatal overdoses and chronic wounds. Given the nascency of this substance, the microbial environment of the wounds it causes has not been well-studied. We hypothesize that there is an increase in polymicrobial infections with the emergence of xylazine in intravenous drug use (IVDU) patients.
METHODS
A retrospective chart review of patients with upper extremity infections between the years 2016 and 2021 was conducted. Only patients with positive microbial culture data were included. Demographics, treatment, culture data, comorbidities, and lab values were collected. Patients were separated into groups according to intravenous drug use (IVDU) status. We also compared patients with polymicrobial infections to those with monomicrobial infections. A multivariate analysis of risk factors associated with polymicrobial infection was also performed.
RESULTS
In total, 211 patients were included. The most common culture result in IVDU patients was a polymicrobial infection (34.6%) followed by MRSA (20.5%) and S pyogenes (20.5%). In non-IVDU patients, the most common culture result was MSSA (26.5%) followed by MRSA (21.4%) and polymicrobial infection (20.4%). Throughout the study period, there was a significant rise in the frequency of polymicrobial infections (p<0.01). Patients with polymicrobial infections were more likely to be IVDU (p=0.02), HIV positive (p=0.04), have diabetes (p<0.01), and have hepatitis C (p=0.02). On multivariate analysis, independent risk factors associated with polymicrobial infection included IVDU (p<0.01) and diabetes (p=0.02).
CONCLUSIONS
With the emergence of xylazine, polymicrobial infections have surpassed MRSA as being the most common culture result in IVDU patients with acute hand infections. Polymicrobial infections continue to increase in the IVDU population compared to prior years. This is likely due to xylazine's vasoconstrictive effect which causes characteristic wounds and an environment suitable for polymicrobial infections.
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