7
Table 3. Foot infection grading in Wound, Ischemia, and foot
Infection (WIfI) classification
Clinical manifestation of infection SVS
IDSA/PEDIS
infection
severity
No symptoms or signs of infection 0 Uninfected
Infection present, as defined by the presence of at least two of
the following items:
• Local swelling or induration
• Erythema >0.5 to ≤2 cm around the ulcer
• Local tenderness or pain
• Local warmth
• Purulent discharge (thick, opaque to white, or
sanguineous secretion)
1 Mild
Local infection involving only the skin and the subcutaneous tissue (without
involvement of deeper tissues and without systemic signs as described below).
Exclude other causes of an inflammatory response of the skin (eg, trauma, gout, acute
Charcot neuro-osteoarthropathy, fracture, thrombosis, venous stasis).
Local infection (as described above) with erythema >2 cm
or involving structures deeper than skin and subcutaneous
tissues (eg, abscess, osteomyelitis, septic arthritis, fasciitis)
and no systemic inflammatory response signs (as described
below).
2 Moderate
Local infection (as described above) with the signs of SIRS,
as manifested by two or more of the following :
• Temperature >38ºC or <36ºC
• Heart rate >90 beats/min
• Respiratory rate >20 breaths/min or Paco
2
<32 mm Hg
• White blood cell count >12,000 or <4000 cells/mm
3
or
10% immature (band) forms
3
Severe
a
a
Ischemia may complicate and increase the severity of any infection. Systemic infection may
sometimes be manifested with other clinical findings, such as hypotension, confusion, and
vomiting, or evidence of metabolic disturbances, such as acidosis, severe hyperglycemia, and new-
onset azotemia.
