Monica Raymond, an infection preventionist at the University of Vermont Medical Center, remarked that some of the wounds she encounters are unlike anything she’s ever seen.
“Some of these are very extensive, even down to the bone,” Raymond noted.
Two years ago, physicians at the UVM Medical Center started noticing an increase in patients presenting with severe, necrotic flesh wounds. Blood cultures consistently revealed the same diagnosis: group A strep infections, commonly referred to as ‘GAS.’
The appearance of the wounds resembled the effects of xylazine, an animal sedative known as ‘tranq’ on the streets, which dealers were already mixing with opioids. This drug induces necrotic wounds that serve as entry points for bacteria. The Vermont Department of Health highlighted the growing role of xylazine in fatal opioid overdoses in the state in October 2021.
Upon studying the UVMMC patients, Raymond found a correlation: There were seven GAS infections identified during 2020 and 2021, but the number surged to 64 from 2022 to October 2023, marking a 900% increase between the two-year periods.
Of the 64 infections in the 2022-2023 period, 70% occurred in individuals who reported injecting drugs, the majority of whom were homeless. Xylazine exposure was self-reported or suspected by a clinician in nearly half of these cases.
Raymond presented her findings to a small group of journalists during a virtual press conference on Tuesday, joined by Dr. Lindsay Smith, an infectious disease physician at UVMMC who treated many of the patients.
“We’re still admitting numerous people with streptococcus,” Smith noted, indicating that while they didn’t have figures for this year yet, the rate of admissions for GAS infection seemed consistent with 2023.
While addressing the root causes of homelessness and substance use is crucial, Raymond suggested that more could be done to protect drug users.
“Homeless individuals need access to basic hygiene facilities. They also require wound care services,” she emphasized, highlighting xylazine test strips as another valuable resource.
Smith agreed, stressing the importance of establishing trust and comfort between healthcare providers and drug users. Half of the injection drug users diagnosed with GAS infections in the UVMMC study either declined hospital admission or left against medical advice before completing antibiotic therapy.
Lastly, Raymond emphasized that the study highlighted the broader risks associated with drug addiction beyond overdoses.
“We often don’t hear about the many other negative consequences of drug addiction, such as these bloodstream infections,” she pointed out.
Left untreated, a GAS infection can escalate to a life-threatening condition, the healthcare providers cautioned. During the study period, two patients developed sepsis and succumbed to multi-organ failure.
