{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:05:39Z","timestamp":1790611539319,"version":"4.1.0"},"reference-count":22,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,8,15]],"date-time":"2017-08-15T00:00:00Z","timestamp":1502755200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012068","name":"Health and Care Research Wales","doi-asserted-by":"publisher","award":["1018"],"award-info":[{"award-number":["1018"]}],"id":[{"id":"10.13039\/100012068","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet. Med."],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Deciding if a diabetic foot ulcer is infected in a community setting is challenging without validated point\u2010of\u2010care tests. Four inflammatory biomarkers were investigated to develop a composite algorithm for mildly infected diabetic foot ulcers: venous white cell count, C\u2010reactive protein (<jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content>) and procalcitonin, and a novel wound exudate calprotectin assay. Calprotectin is a marker of neutrophilic inflammation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a prospective study, people with uninfected or mildly infected diabetic foot ulcers who had not received oral antibiotics in the preceding 2 weeks were recruited from community podiatry clinics for measurement of inflammatory biomarkers. Antibiotic prescribing decisions were based on clinicians\u2019 baseline assessments and participants were reviewed 1 week later; ulcer infection was defined by clinicians\u2019 overall impression from their two assessments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Some 363 potential participants were screened, of whom 67 were recruited, 29 with mildly infected diabetic foot ulcers and 38 with no infection. One participant withdrew early in each group. Ulcer area was 1.32 cm<jats:sup>2<\/jats:sup> [interquartile range (<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content>) 0.32\u20133.61 cm<jats:sup>2<\/jats:sup>] in infected ulcers and 0.22 cm<jats:sup>2<\/jats:sup> (<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content> 0.09\u20131.46 cm<jats:sup>2<\/jats:sup>) in uninfected ulcers. Baseline <jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content> for mild infection was 9.00 mg\/ml and 6.00 mg\/ml for uninfected ulcers; most procalcitonin levels were undetectable. Median calprotectin level in infected diabetic foot ulcers was 1437 ng\/ml and 879 ng\/ml in uninfected diabetic foot ulcers. Area under the receiver operating characteristic curve for a composite algorithm incorporating calprotectin, <jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content>, white cell count and ulcer area was 0.68 (95% confidence intervals 0.52\u20130.82), sensitivity 0.64, specificity 0.81.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A composite algorithm including <jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content>, calprotectin, white cell count and ulcer area may help to distinguish uninfected from mildly infected diabetic foot ulcers. Venous procalcitonin is unhelpful for mild diabetic foot ulcer infection.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.13431","type":"journal-article","created":{"date-parts":[[2017,7,22]],"date-time":"2017-07-22T14:42:38Z","timestamp":1500734558000},"page":"255-261","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Levels of wound calprotectin and other inflammatory biomarkers aid in deciding which patients with a diabetic foot ulcer need antibiotic therapy (<scp>INDUCE<\/scp> study)"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5257-1142","authenticated-orcid":false,"given":"J. R.","family":"Ingram","sequence":"first","affiliation":[{"name":"Division of Infection and Immunity Cardiff University Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Cawley","sequence":"additional","affiliation":[{"name":"Podiatry Department Cardiff and Vale University Health Board Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Coulman","sequence":"additional","affiliation":[{"name":"Centre for Trials Research College of Biomedical and Life Sciences Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Gregory","sequence":"additional","affiliation":[{"name":"Division of Population Medicine Cardiff University Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Thomas\u2010Jones","sequence":"additional","affiliation":[{"name":"Centre for Trials Research College of Biomedical and Life Sciences Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Pickles","sequence":"additional","affiliation":[{"name":"Centre for Trials Research College of Biomedical and Life Sciences Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Cannings\u2010John","sequence":"additional","affiliation":[{"name":"Centre for Trials Research College of Biomedical and Life Sciences Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. 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