Top 5 Takeaways

  1. Increase in Group A Streptococcus Bacteremia: The University of Vermont Medical Center noted a substantial rise in cases of group A streptococcal bloodstream infections during 2022–2023, primarily among persons who inject drugs (PWID), coinciding with xylazine’s emergence in the drug supply.
  2. Impact of Xylazine: Xylazine, associated with necrosis at injection sites, may facilitate the entry of bacteria into the bloodstream, contributing significantly to the uptick in infections.
  3. Demographic and Health Data: The majority of the bacteremia cases occurred in PWID; 55% were female, and many were homeless at the time of diagnosis. Concurrent skin and soft tissue infections were prevalent among these patients.
  4. Healthcare Utilization and Outcomes: Patients frequently sought care for wounds before bacteremia diagnosis, yet many declined hospital admission or left against medical advice. Hospital stays averaged 11 days, with interventions including wound debridement.
  5. Public Health Implications and Actions: Increased access to wound care services in locations accessible to PWID could prevent these severe infections. UVMMC is enhancing care linkage and collaborating with local organizations to deliver community-based wound care services.

Original Article Author and Citation

Corresponding Author:

Monica J. Raymond, MPH, MS –

Suggested Citation:

Raymond MJ, Wolfe TR, Smith LM. Notes from the Field: Group A Streptococcus Bacteremia in Persons Who Inject Drugs — Northern Vermont, January 2020–October 2023. MMWR Morb Mortal Wkly Rep 2024;73:382–384. DOI:


The report discusses a marked increase in cases of community-acquired Group A Streptococcus (GAS) bacteremia at the University of Vermont Medical Center (UVMMC) from January 2020 to October 2023. The spike in cases was predominantly observed among persons who inject drugs (PWID), coinciding with the introduction of xylazine, a substance linked to severe tissue damage, into the local drug supply.


The study employed retrospective analysis of medical records from the UVMMC to identify cases of GAS bacteremia. Criteria included documentation of Streptococcus pyogenes in blood cultures from patients not recently hospitalized or post-surgery. The analysis highlighted the correlation between GAS bacteremia incidence and xylazine exposure, using patient self-reports and clinician observations of related wound characteristics.


The investigation revealed that a significant number of GAS bacteremia cases were associated with concurrent skin infections and the presence of xylazine in the drug supply. Many patients experienced homelessness, which may exacerbate the risk of exposure to harmful substances and hinder access to timely medical care. The findings underscore the critical need for targeted public health interventions to address wound care and drug use.


The increase in GAS bacteremia cases at UVMMC points to the broader implications of drug contamination with substances like xylazine that contribute to severe health outcomes. Strengthening community health resources, particularly accessible wound care and substance use treatment services, is vital for preventing such infections and improving health outcomes for vulnerable populations. The hospital and local health agencies are actively working to improve care linkage and preventive measures for PWID.

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