diabetic foot infection

Table I. Wagner classification and associated pathogens.


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Grade Definition Typical pathogens

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Zero No ulcer “Normal” skin flora
One Superficial skin ulcer Predominantly gram-positives, (Streptococcus,
Two Deep ulcer extending through the Staphylococcus, Enterococcus spps.) lesser
dermis. Tendon, ligaments, numbers of aerobic gram-negatives and anaerobes.
joint capsule or bone may be exposed Bacterial population is more homogenous
Three Deep ulcer with abscess, Polymicrobial (gram-positive, gram-negative
osteomyelitis or joint sepsis and anaerobic) infections with increased number
Four Localized gangrene - forefoot or heel of the latter two species. Bacterial population is
Five Gangrene of the foot more heterogeneous

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