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On the basis of pre\u2010determined criteria, we reviewed prospective controlled, as well as non\u2010controlled, studies in English. We then developed evidence statements based on the included papers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We selected a total of 64 papers that met our inclusion criteria. The certainty of the majority of the evidence statements was low because of the weak methodology of nearly all of the studies. The available data suggest that diagnosing diabetic foot infections on the basis of clinical signs and symptoms and classified according to the International Working Group of the Diabetic Foot\/Infectious Diseases Society of America scheme correlates with the patient's likelihood of the need for hospitalisation, lower extremity amputation, and risk of death. Elevated levels of selected serum inflammatory markers such as erythrocyte sedimentation rate (ESR), C\u2010reactive protein and procalcitonin are supportive, but not diagnostic, of soft tissue infection. Culturing tissue samples of soft tissues or bone, when care is taken to avoid contamination, provides more accurate microbiological information than culturing superficial (swab) samples. Although non\u2010culture techniques, especially next\u2010generation sequencing, are likely to identify more bacteria from tissue samples including bone than standard cultures, no studies have established a significant impact on the management of patients with DFIs. In patients with suspected diabetic foot osteomyelitis, the combination of a positive probe\u2010to\u2010bone test and elevated ESR supports this diagnosis. Plain X\u2010ray remains the first\u2010line imaging examination when there is suspicion of diabetic foot osteomyelitis (DFO), but advanced imaging methods including magnetic resonance imaging (MRI) and nuclear imaging when MRI is not feasible help in cases when either the diagnosis or the localisation of infection is uncertain. Intra\u2010operative or non\u2010per\u2010wound percutaneous biopsy is the best method to accurately identify bone pathogens in case of a suspicion of a DFO. Bedside percutaneous biopsies are effective and safe and are an option to obtain bone culture data when conventional (i.e. surgical or radiological) procedures are not feasible.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The results of this systematic review of the diagnosis of diabetic foot infections provide some guidance for clinicians, but there is still a need for more prospective controlled studies of high quality.<\/jats:p><\/jats:sec>","DOI":"10.1002\/dmrr.3723","type":"journal-article","created":{"date-parts":[[2023,9,16]],"date-time":"2023-09-16T09:14:38Z","timestamp":1694855678000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Diagnosis of infection in the foot of patients with diabetes: A systematic review"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5720-8908","authenticated-orcid":false,"given":"\u00c9ric","family":"Senneville","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases Gustave Dron Hospital  Tourcoing France"},{"name":"Univ\u2010Lille  Lille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaina","family":"Albalawi","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Endocrinology Memorial University  St. John's Newfoundland Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne A.","family":"van Asten","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology Leiden University Medical Centre  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zulfiqarali G.","family":"Abbas","sequence":"additional","affiliation":[{"name":"Abbas Medical Centre Muhimbili University of Health and Allied Sciences  Dar es Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geneve","family":"Allison","sequence":"additional","affiliation":[{"name":"Department of Medicine Tufts Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Arag\u00f3n\u2010S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Department of Surgery La Paloma Hospital  Las Palmas de Gran Canaria Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Embil","sequence":"additional","affiliation":[{"name":"Alberta Public Laboratories University of Alberta Hospital  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence A.","family":"Lavery","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majdi","family":"Alhasan","sequence":"additional","affiliation":[{"name":"Department of Medicine Prisma Health\u2010Midlands  Columbia South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orhan","family":"Oz","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery UT Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilker","family":"U\u00e7kay","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Balgrist University Hospital  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vilma","family":"Urban\u010di\u010d\u2010Rovan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University Medical Centre University of Ljubljana  Ljubljana Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhang\u2010Rong","family":"Xu","sequence":"additional","affiliation":[{"name":"Diabetes Centre The 306th Hospital of PLA  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar J. 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