Validation of the Infectious Diseases Society of America's Diabetic Foot Infection Classification System

Lavery, Lawrence A.; Armstrong, David G.; Murdoch, Douglas P.; Peters, Edgar J.G.; Lipsky, Benjamin A.

doi:10.1086/511036

Cited by 315 publications

(282 citation statements)

References 22 publications

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“…The presence of local cellulitis, erythema, foul odour, warmth and/or purulence was used to indicate infection [13], for which intravenous broad-spectrum antibiotic therapy was immediately prescribed. At discharge, each patient was provided with a therapeutic shoe with a rigid sole and Velcro closure suitable for holding a bandaged foot (Optima Molliter, Civitanova Marche, Italy).…”

Section: Methodsmentioning

confidence: 99%

Prospective study on microangiopathy in type 2 diabetic foot ulcer

et al. 2016

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Aims/hypothesis We investigated the significance of microangiopathy in the development of foot ulcer, which is still disputed. Methods We assessed microangiopathy by histological analysis of the capillary ultrastructure using transmission electron microscopy and capillary density and arteriolar morphology in paraffin-embedded sections from the skin of type 2 diabetic patients: 30 neuroischaemic patients (Isc) revascularised with peripheral angioplasty and 30 neuropathic patients (Neu) with foot ulcer, compared with ten non-diabetic volunteers. Results In the diabetic patients, capillaries in the dermal papillary layer were fewer (−22.2%, 159 ± 43 vs 205 ± 52 mm 2 in non-diabetic volunteers, p < 0.01). They also showed detrimental remodelling, with a 2.2-fold increase in capillary basement membrane thickness (3.44 ± 1.19 vs 1.53 ± 0.34 μm in non-diabetic volunteers, p < 0.001) and a 57.7% decrease in lumen area (14.6 ± 11.1 vs 34.7 ± 27.5 μm 2 , p < 0.001). No differences were observed between the diabetic Isc or Neu patients. Isc were more prone to develop arteriolar occlusion than Neu (16.8 ± 6.9% vs 6.7 ± 3.7%, respectively, p < 0.001).No patient had been amputated at 30 days and healing time was significantly longer in Isc (180 ± 120 vs 64 ± 50 days in Neu, p < 0.001). Conclusions/interpretation Capillary microangiopathy is present in equal measure in neuroischaemic and neuropathic diabetic foot skin. The predominance of arteriolar occlusions with neuroischaemia indicated the existence of an additional 'small vessel disease' that did not affect an effective revascularisation and did not worsen the prognosis of major amputations but slowed the healing process of the neuroischaemic foot ulcer. Trial registration: ClinicalTrials.gov NCT02610036.

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Section: Methodsmentioning

confidence: 99%

Prospective study on microangiopathy in type 2 diabetic foot ulcer

et al. 2016

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“…In addition to the reduction in the vasodilatory response in diabetes occurs overproduction of vasoconstrictor substances such as endothelin 1. This endothelial dysregulation causes structural and functional alterations that characterize the later diabetic arterial disease [67][68][69] . Another atherosclerotic pathogenetic background is an inflammatory activation.…”

Section: Table 8 Diabetic Foot Infection Classification Schemes: Infementioning

confidence: 99%

Diabetic foot syndrome: Immune-inflammatory features as possible cardiovascular markers in diabetes

Tuttolomondo

Maida

Pinto

2015

WJO

122

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“…Approximately one-fourth of people with diabetes will develop an ulcer during their lifetime, and as many as half of these ulcers will become infected (2) (3) . In people with diabetes and foot ulcers, several factors, such as inappropriate antibiotic treatment, the chronic nature of the wound, and frequent hospital admission, can infl uence the presence of multidrug-resistant microorganisms in the ulcer (4) .…”

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confidence: 99%