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Clinical Research
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Validation of the infectious disease society of americaÕs diabetic foot infection classification system First Author: Lawrence Lavery Authors: Lawrence A. Lavery, David G. Armstrong, Douglas P. Murdoch, Edgar J.G. Peters, Benjamin A. Lipsky Background. The Infectious Disease Society of America (IDSA) diabetic foot infection committee devised a severity classification scheme based on expert consensus. We used data from a prospective study of diabetic patients to evaluate the association of clinical outcomes with the IDSA classification scheme. Methods. As part of a program to prevent diabetes-related lower extremity complications, we evaluated 1,666 patients at baseline and then followed them for an average of 27.2 months. We classified all lower extremity wounds as non-infected, or having mild, moderate or severe infection, based on the presence of the local and systemic factors in the IDSA classification. Results. A total of 247 (14.8%) patients developed a diabetic foot wound and 151 (9.1%) developed a foot infection. All but one of the patients with a foot infection had a preceding or concomitant foot wound. Using the IDSA system, we classified 71 (47.0%) of the foot infections as mild, 52 (34%) moderate and 27 (17.9%) severe. One patient (0.6%) without a recognizable portal of entry was excluded. With increasing IDSA infection severity there was a trend toward an increased risk for amputation (X2trend = 108.0, P <0.0001), higher level amputation (X2trend = 113.3, P <0.0001). and requirement for lower extremity related-infection related hospitalization(s) (X2trend = 118.6, P <0.0001). Conclusions. These results suggest that the IDSA infection classification system helps predict important clinical outcomes of infected diabetic foot wounds. The simplicity of system coupled its potential clinical utility may make it a useful instrument for grading infections. |
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