Multidisciplinary Guidance to Care for Persons With Xylazine-Associated Wounds

Xylazine, an adulterant of unregulated opioid supplies, is increasingly prevalent in the United States and associated with distinctive wounds. Xylazine-associated wounds (XAWs) are primarily noted in the extremities and are not always associated with injection drug use. XAWs are often chronic and can become superinfected, posing a great challenge to clinical care. We share multidisciplinary guidance to care for persons with XAWs: (1) substance use disorder treatment and longitudinal multidisciplinary care including addiction medicine, wound care, infectious diseases, and surgery are imperative; (2) avoid aggressive debridement; (3) administer empirical antibiotics for methicillin-resistant Staphylococcus aureus (MRSA)– and group A Streptococcus (GAS)–infected wounds, specifically oral trimethoprim-sulfamethoxazole for MRSA and oral β-lactams for GAS; (4) administer intravenous daptomycin to reduce the discomfort and challenges associated with frequent phlebotomy for vancomycin therapeutic drug monitoring; and (5) create explicit contingency antibiotic plans with potential use of linezolid, tedizolid, or dalbavancin for patient-directed hospital discharge.