The Infectious Diseases Society of America (ISDA) and International Working Group on the Diabetic Foot (IWGDF) use a similar clinical classification scheme for infections of the diabetic foot.
Patient selection: diabetic with wound on foot
Parameters:
(1) local signs of inflammation or minor infection
(2) local signs of significant infection or complications
(3) systemic signs of the inflammatory response
Inflammation or Minor Infection |
Local Signs of Significant Infection |
Systemic Findings |
IDSA |
IWGDF |
none |
none |
none |
uninfected |
1 |
>= 2 |
none |
none |
mild |
2 |
NA |
>= 1 |
none |
moderate |
3 |
NA |
>= 1 |
present |
severe |
4 |
where:
• The presence of a single local sign of inflammation does not fit into a category. I will use an intermediate level (between IWGDF 1 and 2; minimal for IDSA)
Local signs of inflammation or minor infection:
(1) purulence or erythema <= 2 cm around the wound
(2) pain
(3) tenderness
(4) warmth
(5) induration
Any infection is limited to skin or superficial subcutaneous tissue
Local signs of significant infection or complications:
(1) cellulitis > 2 cm around the wound
(2) lymphangitis
(3) spread beneath fascia
(4) deep tissue abscess
(5) gangrene
(6) muscle, tendon, joint and/or bone involvement (including osteomyelitis)
Systemic findings of infection:
(1) fever
(2) chills
(3) tachycardia
(4) hypotension
(5) confusion
(6) vomiting
(7) leukocytosis
(8) acidosis
(9) hyperglycemia
(10) azotemia
Purpose: To classify a diabetic foot lesion based on the criteria of the Infectious Diseases Society of America (IDSA) and IWGDF.
Specialty: Infectious Diseases, Endocrinology
Objective: severity, prognosis, stage
ICD-10: Z86.3, E10-E14,