Table 1.
Classification and grading of DFU infections
| Clinical manifestations of infection | IWGDF grade40
IDSA classification40 |
|---|---|
| No systemic or local signs of infection | 1 (uninfected) |
| Local infection* involving only the skin or subcutaneous tissue (without involvement of deeper tissues and without signs of a systemic inflammatory response syndrome†); any erythema present extends 0.5 to 2 cm around the wound | 2 (mild infection) |
| Local infection* with erythema > 2 cm around the wound, or involving structures deeper than skin and subcutaneous tissues (e.g. abscess, osteomyelitis, septic arthritis, fasciitis) and no signs of a systemic inflammatory response syndrome† | 3 (moderate infection) |
| Local infection* with signs of a systemic inflammatory response syndrome† | 4 (severe infection) |
Local infection is defined as the presence of at least two of the following: local swelling or induration; erythema > 0.5 cm around the ulcer in any direction; local tenderness or pain; local warmth; and purulent discharge. Other causes of inflammatory response of the skin (e.g. trauma, gout, acute Charcot neuroarthropathy, fracture, thrombosis, venous stasis) should be excluded
Systemic inflammatory response syndrome is defined as the presence of at least two of the following: temperature > 100.4 °F (38 °C) or < 96.8 °F (36 °C); heart rate > 90 beats per minute; respiratory rate > 20 breaths per minute or partial pressure of arterial carbon dioxide < 32 mmHg; white blood cell count > 12 000 per μL (12.00 × 109per L) or < 4000 per μL (4.00 × 109per L) or ≥ 10% immature band forms