Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
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..

PubMed Disclaimer

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

References

    1. Esposito S, Noviello S, Leone S. Epidemiology and microbiology of skin and soft tissue infections. Curr Opin Infect Dis 2016; 29:109–15. - PubMed
    1. Lipsky BA, Berendt AR, Cornia PB, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2012; 54:e132–73. - PubMed
    1. Lipsky BA, Aragón-Sánchez J, Diggle M, et al. IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes. Diabetes Metab Res Rev 2016; 32:45–74. - PubMed
    1. Stevens D. Infections of the skin, muscles, and soft tissues. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 18th ed. New York, NY: Mc-Graw Hill Professional Publishing; 2015: Chapter 156.
    1. Cross L. The classification and management of skin and soft tissue infections. Int Emerg Nurs 2013; 21:84–8. - PubMed