{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:43:30Z","timestamp":1792629810884,"version":"4.5.0"},"reference-count":50,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Wound Journal"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Diabetic foot infection (DFI) is a major cause of lower\u2010extremity amputation. Evidence on optimal management remains inconsistent, and real\u2010world data from multidisciplinary centres are limited. This study describes the characteristics, treatment patterns, and outcomes of patients with DFI at a tertiary referral centre. This retrospective cross\u2010sectional study included all patients with diabetes and confirmed DFI presenting since 2022. Demographic, clinical, laboratory, radiologic, and wound\u2010related data were recorded, and wounds were classified using the Wound, Ischemia, and foot Infection (WIfI) system. Correlation and multiple linear regression analyses identified predictors of healing duration. 69 patients were included (mean age 56.4\u2009\u00b1\u200913.2\u2009years; 58% male). Most wounds were deep (88.2%); osteomyelitis occurred in 42.2%. Conservative wound care was used in 73.9%, and 79.7% underwent bedside debridement. Minor and major amputation rates were 16.2% and 1.4%. The median healing time was 45\u2009days (interquartile range [IQR] 54), and the mean healing time was 56.0\u2009\u00b1\u200944.9\u2009days. Healing duration correlated with wound grade, WIfI stage, infection severity, erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, international normalized ratio (INR), wound area, and delay to specialist assessment. Wound grade was the only independent predictor of healing time (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009=\u20090.606,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.001). Limb\u2010preserving management was associated with a low major amputation rate. Wound severity was the strongest determinant of healing duration, underscoring the importance of early referral and structured risk stratification in DFI care.\n                  <\/jats:p>","DOI":"10.1111\/iwj.71082","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T23:26:34Z","timestamp":1792625194000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Navigating Treatment Pathways in Diabetic Foot Infection: A Practical Retrospective Analysis of Healing Predictors and the\n                    <scp>WIfI<\/scp>\n                    System"],"prefix":"10.1111","volume":"23","author":[{"given":"Arefeh","family":"Tabashiri","sequence":"first","affiliation":[{"name":"School of Medicine Shahid Beheshti University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemeh","family":"Ghodratnia","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery Shahid Beheshti University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pourya","family":"Sam Daliri","sequence":"additional","affiliation":[{"name":"School of Medicine Shahid Beheshti University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Farahani","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital Shahid Beheshti University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sepehr Golaghapour","family":"Niazi","sequence":"additional","affiliation":[{"name":"Student Research Committee, School of Medicine Mazandaran University of Medical Sciences  Sari Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Homayoun","family":"Rezaee","sequence":"additional","affiliation":[{"name":"School of Medicine Shahid Beheshti University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4440-335X","authenticated-orcid":false,"given":"Ilad","family":"Alavi Darazam","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital Shahid Beheshti University of Medical Sciences  Tehran Iran"},{"name":"Infectious Diseases and Tropical Medicine Research Center Shahid Beheshti University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"issue":"2","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.dsx.2016.06.023","article-title":"Understanding Diabetic Foot Infection and Its Management","volume":"11","author":"Noor S.","year":"2017","journal-title":"Diabetes and Metabolic Syndrome: Clinical Research and Reviews"},{"issue":"1","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"209","DOI":"10.2337\/dci22-0043","article-title":"Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers","volume":"46","author":"McDermott K.","year":"2023","journal-title":"Diabetes Care"},{"issue":"2","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1080\/07853890.2016.1231932","article-title":"Global Epidemiology of Diabetic Foot Ulceration: A Systematic Review and Meta\u2010Analysis","volume":"49","author":"Zhang P.","year":"2017","journal-title":"Annals of Medicine"},{"issue":"1","key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1007\/s00125-006-0491-1","article-title":"High Prevalence of Ischaemia, Infection and Serious Comorbidity in Patients With Diabetic Foot Disease in Europe. Baseline Results From the Eurodiale Study","volume":"50","author":"Prompers L.","year":"2007","journal-title":"Diabetologia"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","unstructured":"A. J.Boulton D. G.Armstrong M. J.Hardman et\u00a0al. \u201cDiagnosis and Management of Diabetic Foot Infections \u201d2020.","DOI":"10.2337\/db2020-01"},{"issue":"3","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"789","DOI":"10.2337\/dc13-1526","article-title":"Antibiotics Versus Conservative Surgery for Treating Diabetic Foot Osteomyelitis: A Randomized Comparative Trial","volume":"37","author":"L\u00e1zaro\u2010Mart\u00ednez J. L.","year":"2014","journal-title":"Diabetes Care"},{"issue":"9","key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.3390\/jcm10091943","article-title":"Long\u2010Term Complications After Surgical or Medical Treatment of Predominantly Forefoot Diabetic Foot Osteomyelitis: 1 Year Follow Up","volume":"10","author":"Tard\u00e1guila\u2010Garc\u00eda A.","year":"2021","journal-title":"Journal of Clinical Medicine"},{"issue":"6","key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.3390\/jcm10061237","article-title":"Medical Versus Surgical Treatment for the Management of Diabetic Foot Osteomyelitis: A Systematic Review","volume":"10","author":"Tard\u00e1guila\u2010Garc\u00eda A.","year":"2021","journal-title":"Journal of Clinical Medicine"},{"key":"e_1_2_11_10_1","volume-title":"Open Forum Infectious Diseases","author":"Truong D. H.","year":"2022"},{"key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1002\/dmrr.2247","article-title":"A Systematic Review of the Effectiveness of Interventions in the Management of Infection in the Diabetic Foot","volume":"28","author":"Peters E.","year":"2012","journal-title":"Diabetes\/Metabolism Research and Reviews"},{"issue":"2","key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1093\/clinids\/23.2.286","article-title":"Can Aggressive Treatment of Diabetic Foot Infections Reduce the Need for Above\u2010Ankle Amputation?","volume":"23","author":"Tan J. 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L.","year":"2008","journal-title":"Diabetologia"},{"issue":"1","key":"e_1_2_11_18_1","doi-asserted-by":"crossref","first-page":"e3282","DOI":"10.1002\/dmrr.3282","article-title":"Interventions in the Management of Infection in the Foot in Diabetes: A Systematic Review","volume":"36","author":"Peters E. J. G.","year":"2020","journal-title":"Diabetes\/Metabolism Research and Reviews"},{"key":"e_1_2_11_19_1","doi-asserted-by":"crossref","first-page":"947","DOI":"10.2147\/DMSO.S181198","article-title":"Optimal Management of Diabetic Foot Osteomyelitis: Challenges and Solutions","volume":"12","author":"L\u00e1zaro Mart\u00ednez J. L.","year":"2019","journal-title":"Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy"},{"issue":"1","key":"e_1_2_11_20_1","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s00508-014-0630-5","article-title":"The Major Predictors of Amputation and Length of Stay in Diabetic Patients With Acute Foot Ulceration","volume":"127","author":"Tabur S.","year":"2015","journal-title":"Wiener Klinische Wochenschrift"},{"issue":"4","key":"e_1_2_11_21_1","doi-asserted-by":"crossref","first-page":"286","DOI":"10.14310\/horm.2002.1245","article-title":"Predictors of Amputation in Diabetics With Foot Ulcer: Single Center Experience in a Large Turkish Cohort","volume":"8","author":"Yesil S.","year":"2009","journal-title":"Hormones (Athens, Greece)"},{"issue":"1","key":"e_1_2_11_22_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.7547\/1010001","article-title":"Acute Phase Reactants Predict the Risk of Amputation in Diabetic Foot Infection","volume":"101","author":"Akinci B.","year":"2011","journal-title":"Journal of the American Podiatric Medical Association"},{"issue":"1","key":"e_1_2_11_23_1","doi-asserted-by":"crossref","first-page":"40","DOI":"10.12968\/jowc.2017.26.1.40","article-title":"Indicators of Prognosis for Admissions From a Specialist Diabetic Foot Clinic: A Retrospective Service Improvement Exercise","volume":"26","author":"Essackjee Z.","year":"2017","journal-title":"Journal of Wound Care"},{"issue":"3","key":"e_1_2_11_24_1","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.diabres.2011.10.034","article-title":"Risk Factors for Lower Extremity Amputation in Diabetic Foot Disease Categorized by Wagner Classification","volume":"95","author":"Sun J. 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J.","year":"2022","journal-title":"Wound Repair and Regeneration"},{"issue":"10","key":"e_1_2_11_30_1","doi-asserted-by":"crossref","first-page":"2693","DOI":"10.2337\/dc14-0051","article-title":"Cultures of Diabetic Foot Ulcers Without Clinical Signs of Infection Do Not Predict Outcomes","volume":"37","author":"Gardner S. E.","year":"2014","journal-title":"Diabetes Care"},{"issue":"1","key":"e_1_2_11_31_1","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12875-020-01363-y","article-title":"The Analysis for Time of Referral to a Medical Center Among Patients With Diabetic Foot Infection","volume":"22","author":"Lin C. W.","year":"2021","journal-title":"BMC Family Practice"},{"issue":"6","key":"e_1_2_11_32_1","doi-asserted-by":"crossref","DOI":"10.1111\/iwj.70515","article-title":"Machine Learning Insights Into Amputation Risk: Evaluating Wound Classification Systems in Diabetic Foot Ulcers","volume":"22","author":"Mostafavi F.","year":"2025","journal-title":"International Wound Journal"},{"issue":"4","key":"e_1_2_11_33_1","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1053\/j.jfas.2023.02.003","article-title":"A Prospective Analysis of the SVS WIfI Classification System to Stratify Immediate and 1\u2010Year Patient Outcomes","volume":"62","author":"Liette M. D.","year":"2023","journal-title":"Journal of Foot and Ankle Surgery"},{"issue":"4","key":"e_1_2_11_34_1","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1016\/j.jvs.2017.12.079","article-title":"The Society for Vascular Surgery Wound, Ischemia, and Foot Infection (WIfI) Classification Independently Predicts Wound Healing in Diabetic Foot Ulcers","volume":"68","author":"Hicks C. W.","year":"2018","journal-title":"Journal of Vascular Surgery"},{"issue":"2","key":"e_1_2_11_35_1","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.ejvs.2021.04.002","article-title":"Factors Associated With Key Outcomes in Diabetes Related Foot Disease: A Prospective Observational Study","volume":"62","author":"Pena G.","year":"2021","journal-title":"European Journal of Vascular and Endovascular Surgery"},{"issue":"3","key":"e_1_2_11_36_1","doi-asserted-by":"crossref","first-page":"114","DOI":"10.5704\/MOJ.2011.018","article-title":"Comparison of WIFi, University of Texas and Wagner Classification Systems as Major Amputation Predictors for Admitted Diabetic Foot Patients: A Prospective Cohort Study","volume":"14","author":"Vera\u2010Cruz P. N.","year":"2020","journal-title":"Malaysian Orthopaedic Journal"},{"issue":"1","key":"e_1_2_11_37_1","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.surge.2022.02.005","article-title":"SVS WIfI Score as a Predictor of Amputation After Onset of CLI: Validation in an Irish Tertiary Vascular Unit","volume":"21","author":"Ahmed Z.","year":"2023","journal-title":"Surgeon"},{"issue":"6","key":"e_1_2_11_38_1","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.1016\/j.jvs.2016.12.123","article-title":"The Society for Vascular Surgery Wound, Ischemia, and Foot Infection (WIfI) Classification System Predicts Wound Healing but Not Major Amputation in Patients With Diabetic Foot Ulcers Treated in a Multidisciplinary Setting","volume":"65","author":"Mathioudakis N.","year":"2017","journal-title":"Journal of Vascular Surgery"},{"issue":"1","key":"e_1_2_11_39_1","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1177\/15347346231208342","article-title":"Association Between the Society for Vascular Surgery (SVS)\u2010WIfI (Wound, Ischemia, Foot Infection) Classification, Wagner\u2010Meggitt Classification, and Amputation Rate in Patients With Diabetic Foot Infection","volume":"23","author":"Benyakorn T.","year":"2024","journal-title":"International Journal of Lower Extremity Wounds"},{"issue":"5","key":"e_1_2_11_40_1","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1007\/s00125-008-0940-0","article-title":"Prediction of Outcome in Individuals With Diabetic Foot Ulcers: Focus on the Differences Between Individuals With and Without Peripheral Arterial Disease. The EURODIALE Study","volume":"51","author":"Prompers L.","year":"2008","journal-title":"Diabetologia"},{"issue":"4","key":"e_1_2_11_41_1","doi-asserted-by":"crossref","first-page":"109","DOI":"10.5758\/vsi.2018.34.4.109","article-title":"Predictors for Amputation in Patients With Diabetic Foot Wound","volume":"34","author":"Kim S.\u2010Y.","year":"2018","journal-title":"Vascular Specialist International"},{"issue":"1","key":"e_1_2_11_42_1","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s12902-020-00568-7","article-title":"Changing the Patterns of Hospitalized Diabetic Foot Ulcer (DFU) Over a 5\u2010Year Period in a Multi\u2010Disciplinary Setting in Thailand","volume":"20","author":"Thewjitcharoen Y.","year":"2020","journal-title":"BMC Endocrine Disorders"},{"issue":"7","key":"e_1_2_11_43_1","doi-asserted-by":"crossref","first-page":"e14931","DOI":"10.1111\/iwj.14931","article-title":"The Incidence of Lower Extremity Amputation and Its Associated Risk Factors in Patients With Diabetic Foot Ulcers: A Meta\u2010Analysis","volume":"21","author":"Luo Y.","year":"2024","journal-title":"International Wound Journal"},{"key":"e_1_2_11_44_1","article-title":"Debridement of Diabetic Foot Ulcers","volume":"1","author":"Edwards J.","year":"2010","journal-title":"Cochrane Database of Systematic Reviews"},{"issue":"1","key":"e_1_2_11_45_1","doi-asserted-by":"crossref","first-page":"6715157","DOI":"10.1155\/jdr\/6715157","article-title":"Challenges and Solutions in Advanced Management of Diabetic Foot Infections: A Review of Recent Studies","volume":"2025","author":"Rashki S.","year":"2025","journal-title":"Journal Diabetes Research"},{"issue":"1","key":"e_1_2_11_46_1","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1177\/15347346231178642","article-title":"Microbiological and Clinical Characteristics of Infected Diabetic Foot Ulcers Managed in a Tertiary Level Diabetic Foot Service","volume":"25","author":"Rossana 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