Clinical, microbiological and inflammatory markers of severe diabetic foot infections

Abstract

Classifying diabetic foot infection (DFI) according to its severity is recommended by the International Working Group on Diabetic Foot (IWGDF). 1 Key issues in patient management, such as the need for hospitalization, urgent evaluation by a foot surgeon and the route of antibiotic administration, may depend on the severity of the infection. 1 The classification system also has prognostic value. 2 The severity scheme validated in 2007 presents a significant association with the risk of amputation and a greater number of amputations and readmissions. 2 According to both the Infectious

Severe diabetic foot infections without systemic inflammatory response syndrome: Prospective validation of a new category

“…However, severe infections with SIRS in the present series were not associated with undergoing a major amputation as previously reported 4,6,11 . In the present series, the rate of major amputations in severe with SIRS was 10.1%, while in other reports, the rate was 14.3%, 11 26% 4 and 32.9% 6 . We have performed a post hoc analysis and can conclude that the low rate of major amputations in the present series limits the statistical power when comparing major amputations between the two groups.…”

“…The authors provide neither any research on which this modification was based, nor a validation of it 10 . We have based our research on a recent retrospective study that reported that a subgroup of moderate infections had a worse prognosis than the remaining moderate infections 6 . We have been able to validate this new category, preferring to define moderate/severe as severe without SIRS, as we did not find any difference when comparing severe infections with or without SIRS.…”

“…Moderate infections are a very heterogeneous group 2,5 . One study recently reported that moderate infections associated with some clinical and laboratory values were associated with worse prognosis 6 . The authors then suggested a modification of the IDSA/IWGDF scheme, including moderate, moderate/severe (or severe without SIRS) and severe DFIs.…”

“…2,5 One study recently reported that moderate infections associated with some clinical and laboratory values were associated with worse prognosis. 6 The authors then suggested a modification of the IDSA/IWGDF scheme, including moderate, moderate/ severe (or severe without SIRS) and severe DFIs. However, this study was retrospective with its limitations, and that modification should prospectively be validated.…”

Keeping score

“…More acutely, the biomarkers associated with severe diabetes foot infection were assessed in 245 patients 5 . Skin necrosis, the erythrocyte sedimentation rate, serum albumin and the neutrophil:lymphocyte ratio predicted the most severe infections but not peripheral arterial disease or the C‐reactive protein.…”