Clinical classification of a diabetic foot infection^*

Infection severity	Clinical manifestations of infection
Uninfected	Wound lacking purulence or any manifestations of inflammation.
Mild	Presence of ≥2 manifestations of inflammation (purulence, or erythema, pain, tenderness, warmth, or induration), but any cellulitis/erythema extends ≤2 cm around the ulcer, and infection is limited to the skin or superficial subcutaneous tissues; no other local complications or systemic illness.
Moderate	Infection (as above) in a patient who is systemically well and metabolically stable but which has ≥1 of the following characteristics: cellulitis extending >2 cm, lymphangitic streaking, spread beneath the superficial fascia, deep-tissue abscess, gangrene, and involvement of muscle, tendon, joint or bone.
Severe	Infection in a patient with systemic toxicity or metabolic instability (eg, fever, chills, tachycardia, hypotension, confusion, vomiting, leukocytosis, acidosis, severe hyperglycemia, or azotemia).

Foot ischemia may increase the severity of any infection, and the presence of critical ischemia often makes the infection severe.

* The International Working Group on the Diabetic Foot has published a similar classification scheme, except in the moderate and severe categories the scheme also notes whether or not the patient has osteomyelitis.

Reference:

Lipsky BA, Senneville É, Abbas ZG, et al. Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev 2020; 36:e3280.

Adapted from: Lipsky BA, Berendt AR, Deery HG, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2004; 39:885.

Graphic 55551 Version 2.0

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Clinical classification of a diabetic foot infection*

Clinical classification of a diabetic foot infection^*