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
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)
Local infection involving only the skin and the subcutaneous tissue (without involvement of deeper tissues and without systemic signs as described below).
2 Mild
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).
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)
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
• White blood cell count > 12,000 or < 4000 cells/mm3
< 32 mmHg or 10% immature (band) forms
a PEDIS: perfusion, extent/size, depth/tissue loss, infection, and sensation b
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.
4 Severeb 3 Moderate
PEDIS Gradea
IDSA Infection Severity
1 Uninfected
6
