Table 1.

IWGDF evidence in the management of severe diabetic foot infection. The quality of evidence was graded ‘high’, ‘moderate’ or ‘low’ based on the risk of bias, and the strength of recommendation rated as ‘weak’ or ‘strong’.

	Guidance from IWGDF for management of severe foot infection	IWGDF evidence grade & Strength
1	Diagnose a soft tissue DFI clinically, based on the presence of local or systemic signs and symptoms of inflammation	(Strong; low)
2	Consider hospitalization of all patients with diabetes and a severe foot infection and those with a moderate infection that is complex or associated with key relevant morbidities.	(Strong; low)
3	Non-surgeons should urgently consult with a surgical specialist in cases of severe infection or of moderate infection complicated by extensive gangrene, necrotizing infection, signs suggesting deep (below the fascia) abscess or compartment syndrome, or severe lower limb ischemia.	(Strong; low)
4	In a patient with probable diabetic foot osteomyelitis with concomitant soft tissue infection, urgently evaluate for the need for surgery as well as intensive post-operative medical and surgical follow-up. (Strong; moderate) but in a patient with uncomplicated forefoot osteomyelitis, you may consider treating with antibiotic therapy without surgical resection of bone	(Strong; moderate)
5	During surgery to resect bone for diabetic foot osteomyelitis, consider obtaining a specimen of bone for culture (and, if possible, histopathology) at the stump of the resected bone to identify if there is residual bone infection. (Weak; moderate) and if an aseptic collected culture specimen obtained during surgery grows pathogens, or if the histology demonstrates osteomyelitis, administer appropriate antibiotic therapy for up to six weeks	(Strong; moderate)
6	Diabetic foot osteomyelitis with antibiotic therapy for no longer than 6 weeks. If the infection does not clinically improve within the first 2–4 weeks, reconsider the need for collecting a bone specimen for culture, undertaking (further) surgical resection, or selecting an alternative antibiotic regimen	(Strong; moderate)