{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T08:00:31Z","timestamp":1792828831228,"version":"4.5.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2019,6,8]],"date-time":"2019-06-08T00:00:00Z","timestamp":1559952000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000041","name":"American Diabetes Association","doi-asserted-by":"publisher","award":["ADA 1-17-ICTS-056"],"award-info":[{"award-number":["ADA 1-17-ICTS-056"]}],"id":[{"id":"10.13039\/100000041","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,4,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>We provide evidence to revise the Infectious Diseases Society of America (IDSA) diabetic foot infection classification by adding a separate tier for osteomyelitis and evaluating if moderate and severe infection criteria improve the classification\u2019s ability to direct therapy and determine outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We retrospectively evaluated 294 patients with moderate and severe infections. Osteomyelitis was confirmed by bone culture or histopathology. Soft tissue infection (STI) was based on negative bone culture, magnetic resonance imaging, or single-photon emission computed tomography. We stratified STI and osteomyelitis using IDSA criteria for moderate and severe infections and compared outcomes and complications.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Osteomyelitis patients had greater antibiotic duration (32.5 \u00b1 46.8 vs 63.8 \u00b1 55.1 days; P &amp;lt; .01), surgery frequency (55.5% vs 99.4%; P &amp;lt; .01), number of surgeries (2.1 \u00b1 1.3 vs 3.3 \u00b1 2.3; P &amp;lt; .01), amputations (26.3% vs 83.4%; P &amp;lt; .01), reinfection (38.0% vs 56.7%; P &amp;lt; .01), and length of stay (14.5 \u00b1 14.9 vs 22.6 \u00b1 19.0 days; P &amp;lt; .01). There were no differences in moderate and severe STI outcomes except for infection readmissions (46.2% vs 25.0%; P = .02), and acute kidney injury (31.2% vs 50.0%; P = .03). There were no differences in moderate and severe osteomyelitis except the number of surgeries (2.8 \u00b1 2.1 vs 4.1 \u00b1 2.5; P &amp;lt; .01) and length of stay (18.6 \u00b1 17.5 vs 28.2 \u00b1 17.7; P &amp;lt; .01).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The IDSA classification better reflects outcomes if risk categories are stratified by STI or osteomyelitis and moderate and severe infections are not categorized separately.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciz489","type":"journal-article","created":{"date-parts":[[2019,6,7]],"date-time":"2019-06-07T11:09:29Z","timestamp":1559905769000},"page":"1573-1579","source":"Crossref","is-referenced-by-count":89,"title":["The Infected Diabetic Foot: Re-evaluating the Infectious Diseases Society of America Diabetic Foot Infection Classification"],"prefix":"10.1093","volume":"70","author":[{"given":"Lawrence A","family":"Lavery","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Easton C","family":"Ryan","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junho","family":"Ahn","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5367-9235","authenticated-orcid":false,"given":"Peter A","family":"Crisologo","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orhan K","family":"Oz","sequence":"first","affiliation":[{"name":"Department of Radiology, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"La Fontaine","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dane K","family":"Wukich","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,6,8]]},"reference":[{"key":"2020041000554478300_CIT0001","volume-title":"Global report on diabetes.","author":"World Health Organization","year":"2016"},{"key":"2020041000554478300_CIT0002","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1111\/iwj.12146","article-title":"Amputations and foot-related hospitalisations disproportionately affect dialysis patients","volume":"12","author":"Lavery","year":"2015","journal-title":"Int Wound J"},{"key":"2020041000554478300_CIT0003","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.2337\/dc05-2425","article-title":"Risk factors for foot infections in individuals with diabetes","volume":"29","author":"Lavery","year":"2006","journal-title":"Diabetes Care"},{"key":"2020041000554478300_CIT0004","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.2337\/diacare.26.5.1435","article-title":"Diabetic foot syndrome: evaluating the prevalence and incidence of foot pathology in Mexican Americans and non-Hispanic whites from a diabetes disease management cohort","volume":"26","author":"Lavery","year":"2003","journal-title":"Diabetes Care"},{"key":"2020041000554478300_CIT0005","doi-asserted-by":"crossref","first-page":"S56","DOI":"10.1002\/dmrr.441","article-title":"Diagnosing and treating diabetic foot infections","volume":"20","author":"Lipsky","year":"2004","journal-title":"Diabetes Metab Res Rev"},{"key":"2020041000554478300_CIT0006","doi-asserted-by":"crossref","first-page":"e132","DOI":"10.1093\/cid\/cis346","article-title":"2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections","volume":"54","author":"Lipsky","year":"2012","journal-title":"Clin Infect Dis"},{"key":"2020041000554478300_CIT0007","doi-asserted-by":"crossref","first-page":"3706","DOI":"10.2337\/dc13-1083","article-title":"SIRS is valid in discriminating between severe and moderate diabetic foot infections","volume":"36","author":"Wukich","year":"2013","journal-title":"Diabetes Care"},{"key":"2020041000554478300_CIT0008","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1086\/511036","article-title":"Validation of the Infectious Diseases Society of America\u2019s diabetic foot infection classification system","volume":"44","author":"Lavery","year":"2007","journal-title":"Clin Infect Dis"},{"key":"2020041000554478300_CIT0009","first-page":"233","article-title":"Consensus document on treatment of infections in diabetic foot","volume":"24","author":"Blanes","year":"2011","journal-title":"Rev Esp Quimioter"},{"key":"2020041000554478300_CIT0010","article-title":"Diabetic foot problems: inpatient management of diabetic foot problems","author":"National Institute for Health and Care Excellence (NICE)","year":"2016","journal-title":"NICE Guidelines"},{"key":"2020041000554478300_CIT0011","first-page":"1","article-title":"Management of diabetic foot infections. Short text. Societe de Pathologie Infectieuse de Langue Francaise","volume":"37","author":"Societe de Pathologie Infectieuse de Langue Francaise","year":"2007","journal-title":"Med Mal Infect"},{"key":"2020041000554478300_CIT0012","doi-asserted-by":"crossref","first-page":"S115","DOI":"10.1086\/383272","article-title":"Controversies in diagnosing and managing osteomyelitis of the foot in diabetes","volume":"39","author":"Jeffcoate","year":"2004","journal-title":"Clin Infect Dis"},{"key":"2020041000554478300_CIT0013","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1086\/516148","article-title":"Osteomyelitis of the foot in diabetic patients","volume":"25","author":"Lipsky","year":"1997","journal-title":"Clin Infect Dis"},{"key":"2020041000554478300_CIT0014","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.2337\/dc17-S005","article-title":"2. Classification and diagnosis of diabetes","volume":"40","author":"American Diabetes Association","year":"2017","journal-title":"Diabetes Care"},{"key":"2020041000554478300_CIT0015","first-page":"1","article-title":"KDIGO Clinical Practice Guideline for Acute Kidney Injury","volume":"2","author":"Kidney Disease: Improving Global Outcomes (KDIGO) acute kidney injury work group","year":"2012","journal-title":"Kidney Inter"},{"key":"2020041000554478300_CIT0016","doi-asserted-by":"crossref","first-page":"e92977","DOI":"10.1371\/journal.pone.0092977","article-title":"Phagocytosis via complement or Fc-gamma receptors is compromised in monocytes from type 2 diabetes patients with chronic hyperglycemia","volume":"9","author":"Restrepo","year":"2014","journal-title":"PLoS One"},{"key":"2020041000554478300_CIT0017","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1111\/j.1574-695X.1999.tb01397.x","article-title":"Immune dysfunction in patients with diabetes mellitus (DM)","volume":"26","author":"Geerlings","year":"1999","journal-title":"FEMS Immunol Med Microbiol"},{"key":"2020041000554478300_CIT0018","doi-asserted-by":"crossref","first-page":"497","DOI":"10.3109\/00365548.2013.765589","article-title":"The implications of the presence of osteomyelitis on outcomes of infected diabetic foot wounds","volume":"45","author":"Mutluoglu","year":"2013","journal-title":"Scand J Infect Dis"},{"key":"2020041000554478300_CIT0019","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1086\/380449","article-title":"Treating foot infections in diabetic patients: a randomized, multicenter, open-label trial of linezolid versus ampicillin-sulbactam\/amoxicillin-clavulanate","volume":"38","author":"Lipsky","year":"2004","journal-title":"Clin Infect Dis"},{"key":"2020041000554478300_CIT0020","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1001\/archinte.159.8.851","article-title":"Outcome of diabetic foot infections treated conservatively: a retrospective cohort study with long-term follow-up","volume":"159","author":"Pittet","year":"1999","journal-title":"Arch Intern Med"},{"key":"2020041000554478300_CIT0021","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1093\/jac\/48.6.927","article-title":"Rifampicin-ofloxacin oral regimen for the treatment of mild to moderate diabetic foot osteomyelitis","volume":"48","author":"Senneville","year":"2001","journal-title":"J Antimicrob Chemother"},{"key":"2020041000554478300_CIT0022","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1177\/107110070602701003","article-title":"Oral antimicrobial therapy for diabetic foot osteomyelitis","volume":"27","author":"Embil","year":"2006","journal-title":"Foot Ankle Int"},{"key":"2020041000554478300_CIT0023","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1001\/jama.299.7.806","article-title":"Does this patient with diabetes have osteomyelitis of the lower extremity?","volume":"299","author":"Butalia","year":"2008","journal-title":"JAMA"},{"key":"2020041000554478300_CIT0024","first-page":"1726","article-title":"Orthopaedic trauma clinical research: is 2-year follow-up necessary? Results from a longitudinal study of severe lower extremity trauma","volume":"71","author":"Castillo","year":"2011","journal-title":"J Trauma"},{"key":"2020041000554478300_CIT0025","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1053\/j.jfas.2011.08.005","article-title":"Statistical reliability of bone biopsy for the diagnosis of diabetic foot osteomyelitis","volume":"50","author":"Meyr","year":"2011","journal-title":"J Foot Ankle Surg"},{"key":"2020041000554478300_CIT0026","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/s10096-015-2544-1","article-title":"The microbiome of diabetic foot osteomyelitis","volume":"35","author":"van Asten","year":"2016","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2020041000554478300_CIT0027","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.crad.2015.10.031","article-title":"Image-guided percutaneous disc sampling: impact of antecedent antibiotics on yield","volume":"71","author":"Agarwal","year":"2016","journal-title":"Clin Radiol"},{"key":"2020041000554478300_CIT0028","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1007\/s00256-018-2972-y","article-title":"Diagnostic yield of repeat CT-guided biopsy for suspected infectious spondylodiscitis","volume":"47","author":"Czuczman","year":"2018","journal-title":"Skeletal Radiol"},{"key":"2020041000554478300_CIT0029","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1007\/s10067-008-1051-5","article-title":"CT-guided fine-needle aspiration in vertebral osteomyelitis: true usefulness of a common practice","volume":"28","author":"de Lucas","year":"2009","journal-title":"Clin Rheumatol"},{"key":"2020041000554478300_CIT0030","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1136\/jcp.2007.054296","article-title":"Value of CT-guided biopsy in the diagnosis of septic discitis","volume":"61","author":"Enoch","year":"2008","journal-title":"J Clin Pathol"},{"key":"2020041000554478300_CIT0031","doi-asserted-by":"crossref","first-page":"2122","DOI":"10.1128\/AAC.05953-11","article-title":"Microbiologically and clinically diagnosed vertebral osteomyelitis: impact of prior antibiotic exposure","volume":"56","author":"Kim","year":"2012","journal-title":"Antimicrob Agents Chemother"},{"key":"2020041000554478300_CIT0032","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1093\/cid\/cir062","article-title":"The impact of prebiopsy antibiotics on pathogen recovery in hematogenous vertebral osteomyelitis","volume":"52","author":"Marschall","year":"2011","journal-title":"Clin Infect Dis"},{"key":"2020041000554478300_CIT0033","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1136\/pgmj.2003.017863","article-title":"Therapeutic impact of percutaneous spinal biopsy in spinal infection","volume":"80","author":"Rankine","year":"2004","journal-title":"Postgrad Med J"},{"key":"2020041000554478300_CIT0034","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/j.jbspin.2016.02.006","article-title":"Diagnostic contribution of a second percutaneous needle biopsy in patients with spontaneous diskitis and negative blood cultures and first biopsy","volume":"83","author":"Terreaux","year":"2016","journal-title":"Joint Bone Spine"},{"key":"2020041000554478300_CIT0035","doi-asserted-by":"crossref","first-page":"e3343","DOI":"10.1097\/MD.0000000000003343","article-title":"Exposure of prebiopsy antibiotics influence bacteriological diagnosis and clinical outcomes in patients with infectious spondylitis","volume":"95","author":"Wang","year":"2016","journal-title":"Medicine"},{"key":"2020041000554478300_CIT0036","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.2214\/AJR.06.1286","article-title":"Imaging-guided bone biopsy for osteomyelitis: are there factors associated with positive or negative cultures?","volume":"188","author":"Wu","year":"2007","journal-title":"AJR Am J Roentgenol"},{"key":"2020041000554478300_CIT0037","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1542\/hpeds.2014-0114","article-title":"Impact of antibiotic pretreatment on bone biopsy yield for children with acute hematogenous osteomyelitis","volume":"5","author":"Zhorne","year":"2015","journal-title":"Hosp Pediatr"},{"key":"2020041000554478300_CIT0038","doi-asserted-by":"crossref","first-page":"24","DOI":"10.7547\/1030024","article-title":"Histopathologic characteristics of bone infection complicating foot ulcers in diabetic patients","volume":"103","author":"Cecilia-Matilla","year":"2013","journal-title":"J Am Podiatr Med Assoc"},{"key":"2020041000554478300_CIT0039","volume-title":"In the active voice: cultural bias","author":"Douglas","year":"1982"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciz489\/28788575\/ciz489.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/70\/8\/1573\/33031700\/ciz489.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/70\/8\/1573\/33031700\/ciz489.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,4,10]],"date-time":"2020-04-10T05:10:09Z","timestamp":1586495409000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/70\/8\/1573\/5513179"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,8]]},"references-count":39,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2019,6,8]]},"published-print":{"date-parts":[[2020,4,10]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciz489","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,4,15]]},"published":{"date-parts":[[2019,6,8]]}}}