Key Points
For definitions of the abbreviations in green, see Table 13.
ÎÎConsider the possibility of infection occurring in any foot wound in a
patient with diabetes (SR-L).
Note: Evidence of infection generally includes classical signs of inflammation (redness,
warmth, swelling, tenderness or pain) or purulent secretions, but may also include
additional or secondary signs (eg, nonpurulent secretions, friable or discolored
granulation tissue, undermining of wound edges, foul odor) (SR-L).
ÎÎSelect and routinely use a validated classification system, such as that
developed by the International Working Group on the Diabetic Foot
(IWGDF)—abbreviated with the acronym PEDIS—or IDSA (Table 3), to
classify infections and to help define the mix of types and severity of
their cases and their outcomes (SR-H).
• The DFI (diabetic foot infection) Wound Score (Table 4) may provide additional
quantitative discrimination for research purposes (WR-L).
• Other validated diabetic foot classification schemes have limited value for
infection, as they describe only its presence or absence (MR-L).
Assessment
ÎÎEvaluate a diabetic patient presenting with a foot wound at 3 levels:
• the patient as a whole
• the affected foot or limb
• the infected wound (SR-L)
ÎÎDiagnose infection based on the presence of at least two classic
symptoms or signs of inflammation (erythema, warmth, tenderness,
pain, or induration) or purulent secretions. Then document and
classify the severity of the infection based on its extent and depth and
the presence of any systemic findings of infection (SR-L).
ÎÎBe aware of factors that increase the risk for DFI and especially
consider infection when they are present. These include:
• a wound for which the probe to bone (PTB) test is positive
• an ulceration present for > 30 days
• a history of recurrent foot ulcers
• a traumatic foot wound
• the presence of peripheral vascular disease in the affected limb
• a previous lower extremity amputation
• loss of protective sensation
• the presence of renal insufficiency
• a history of walking barefoot (SR-L)
ÎÎAssess the affected limb and foot for arterial ischemia (SR-M), venous
insufficiency, presence of protective sensation and for biomechanical
problems (SR-L).
