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Review
. 2016 Dec 7;4(1):ofw255.
doi: 10.1093/ofid/ofw255. eCollection 2017 Winter.

A Proposed New Classification of Skin and Soft Tissue Infections Modeled on the Subset of Diabetic Foot Infection

Benjamin A Lipsky  1 , Michael H Silverman  2 , Warren S Joseph  3
Affiliations
Review

A Proposed New Classification of Skin and Soft Tissue Infections Modeled on the Subset of Diabetic Foot Infection

Benjamin A Lipsky et al. Open Forum Infect Dis. .

Abstract

Schemes for classifying skin and soft tissue infections (SSTIs) pose limitations for clinicians and regulatory agencies. Diabetic foot infections (DFIs) are a subset of SSTIs. We developed and are proposing a classification to harmonize current schemes for SSTIs and DFIs. Existing schemes for classifying SSTIs are limited in both their usefulness to clinicians and to regulatory agencies. The guidelines on SSTI from the Infectious Diseases Society of America (IDSA) and the guidance from the US Food and Drug Administration do not adequately address many types of wound infections. However, guidelines developed by the IDSA for DFIs provide a classification scheme that has been validated and widely used. Diabetic foot infections are similar to SSTIs in pathophysiology, microbiology, and treatment and can be seen as a subset of SSTI. Thus, based on the documents noted above, and our review of the literature, we have developed a proposed classification scheme for SSTI that harmonizes well with the DFI classification. We believe this new scheme will assist clinicians in classifying most wound infections and potentially aid regulatory agencies in testing and approving new antimicrobials for these infections.

Keywords: classification; diabetic foot; skin and soft tissue; topical therapy..

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Figures

Figure 1.
Figure 1.
The typical evolution of a superficial wound infection. The growth of microorganisms in a wound and the host response determine how far along in this spectrum the process goes.
Figure 2.
Figure 2.
Infectious Diseases Society of America classification of skin and soft tissue infections (SSTIs), which does not explicitly include wound infections [4]. C & S, culture and sensitivity; I & D, incision and drainage; MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillin-susceptible S aureus; Rx, treatment; TMP/SMX, trimethoprim-sulfamethoxazole.
Figure 3.
Figure 3.
Approach to the patient with diabetes and a suspected foot infection [3].
See this image and copyright information in PMC

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