10
fI: foot Infection
Clinical manifestation of infection severity SVS
IDSA/PEDIS
infection severity
No symptoms or signs of infection 0 Uninfected
Infection present, as defined by the presence of at
least 2 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 >38° or <36°C
• Heart rate >90 beats/min
• Respiratory rate >20 breaths/min or PaCO
2
<32 mm Hg
• White blood cell count >12,000 or <4000 cu/mm
or 10% immature (band) forms
3
Severe
a
a
Ischemia may complicate and increase the severity of any infection. Systemic infection may
sometimes manifest with other clinical findings – such as hypotension, confusion, vomiting – or
evidence of metabolic disturbances – such as acidosis, severe hyperglycemia, new-onset azotemia.
From Lipsky et al. Clin Infect Dis 2012;54:e132-73.
Table 2. Lower Extremity Threatened Limb (SVS WIfI)
Classification System (cont'd)
Treatment
