Xylazine in drug supply is implicated in dramatic increase in bloodstream infections

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University of Vermont Medical Center researchers found a 900% increase over two years in blood infections linked primarily to people who injected drugs, most of whom were also experiencing homelessness.

Most of the 57 people included in the study, which compared 2022-2023 to 2020-2021, were Chittenden County residents, with a handful from surrounding Addison, Franklin and Grand Isle counties, according to Dr. Linsday Smith, an infectious disease specialist at UVM Medical Center. Two of the people in the study died from their infections.

Smith and Infection Preventionist Monica Raymond suspect the dramatic increase in infections is fueled in part by the increasing presence of xylazine in the illicit drug supply. The study was published last week in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

Raymond said in an email on Tuesday the rate of infection is showing no signs of slowing down in 2024, with four to five cases of blood infections reported per month, 70% being in people who inject drugs.

Xylazine causes wounds so bad they're hard to imagine

Xylazine, a horse tranquilizer, inhibits the blood supply to the skin in people, causing "horrible" wounds, according to Dr. Daniel Wolfson, who works in UVM Medical Center's Emergency Department.

"You couldn't even imagine how bad (the wounds) look, and they're on their face, their legs, their arms. It's not just where they inject," Wolfson told the Burlington Free Press in 2023.

Raymond said she and the infection prevention team suspect xylazine is "playing a role" in the increase of infections by creating the wounds that allow the bacteria to enter the bloodstream. She said 70% of the infections were in people who inject drugs currently or have in the past, and more than half were in people who were homeless.

"Something that stood out is all but one of them had skin wounds," Raymond said in a Zoom meeting Tuesday morning with reporters. "The vast majority had multiple wounds, some very extensive on a good portion of limbs, sometimes down to the bone. These were very serious infections."

We have to address the 'root causes' of bloodstream infections, researcher says

Addressing the root causes of homelessness and drug addiction is "paramount," according to Raymond.

"Homeless people need places to practice basic hygiene, to shower, and in particular they need access to wound care so they're treated before they advance to deep wounds allowing bacteria to enter the bloodstream," Raymond said.

Free care needs to be provided in community settings where people feel comfortable, Raymond added, because this group of patients feels particularly vulnerable and distrustful. Smith said the bloodstream infections typically improve rapidly with two weeks of treatment with antibiotics, either with pills or IV therapy, but it can be difficult to get patients to stick around long enough for the antibiotics to do their work.

"We did find about half of patients either refused to be admitted to the hospital, or left before completing the IV phase of therapy," Raymond said. "They didn't feel comfortable here, they don't trust us or they're worried about going into withdrawal."

It's not just overdoses that cause death and suffering in those battling substance abuse

We need to focus attention on problems like the one the UVM Medical Center team highlighted in its study of bloodstream infections, according to Raymond.

"We hear a lot about overdoses and death from overdose, which is very serious and concerning, but we don't hear about other bad outcomes from drug addiction, such as these bloodstream infections," she said. "It's important to understand the suffering and death is not just from overdoses."

Contact Dan D'Ambrosio at 660-1841 or ddambrosi@gannett.com. Follow him on Twitter @DanDambrosioVT. This coverage is only possible with support from our readers.