Treatment
Table 3. IDSA and International Working Group on the
Diabetic Foot (PEDIS) Classifications of DFI
Clinical Manifestations of Infection
No symptoms or signs of infection
PEDIS
Gradea
IDSA Infection
Severity
1
Uninfected
Local infection involving only the skin and the
subcutaneous tissue (without involvement of deeper
tissues and without systemic signs as described below).
If erythema, must be > 0.5 cm to ≤ 2 cm around the ulcer.
Exclude other causes of an inflammatory response of the
skin (eg, trauma, gout, acute Charcot neuro-
osteoarthropathy, fracture, thrombosis, venous stasis).
2
Mild
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)
3
Moderate
Local infection (as described above) with the signs of
systemic inflammatory response syndrome (SIRS), as
manifested by two or more of the following:
• Temperature > 38° or < 36° Celsius
• Heart rate > 90 beats/min
• Respiratory rate > 20 breaths/minute or
PaCO2 < 32 mmHg
• White blood cell count > 12,000 or
< 4000 cells/mm3 or 10% immature (band) forms
4
Severeb
Infection present, as defined by the presence of at least 2 of
the following items:
• Local swelling or induration
• Erythema (> 0.5 cm)
• Local tenderness or pain
• Local warmth
• Purulent discharge (thick, opaque to white or
sanguineous secretion)
a
b
6
PEDIS: perfusion, extent/size, depth/tissue loss, infection, and sensation
Foot ischemia may increase the severity of any infection, and the presence of critical ischemia often
makes the infection severe. Systemic infection may sometimes manifest with other clinical findings,
such as hypotension, confusion, vomiting, or evidence of metabolic disturbances, such as acidosis,
severe hyperglycemia, or new-onset azotemia.
