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Diabetic Foot Infection

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Key Points For definitions of the abbreviations in green, see Table 13. ÎConsider 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). ÎSelect 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 ÎEvaluate 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) ÎDiagnose 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). ÎBe 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) ÎAssess the affected limb and foot for arterial ischemia (SR-M), venous insufficiency, presence of protective sensation and for biomechanical problems (SR-L).

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