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| ==Diagnostik==
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| ===Diagnosekriterien===
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| <span class="ve-pasteProtect" style="font-size:12.0pt;
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| mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:Calibri;
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| mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;\nmso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}">Die Diagnose einer nosokomialen Ventrikulitis bzw. Meningitis ist schwierig </span><span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:
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| Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><ref name=":0"><span style="color: #333333">28. <span class="ve-pasteprotect"><span data-ve-attributes="{"style":"mso-tab-count:1"}" style="box-sizing: inherit"> <span style="box-sizing: inherit"> </span></span></span>Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Michael Scheld W, van de Beek D, Bleck TP, Garton HJ, Zunt JR: 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis 2017; 64: e34–e65</span></ref><span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:
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| Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">]</span></span><span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:
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| "Times New Roman";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;
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| mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\n\"Times New Roman\";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE"}">. Es gibt verschiedene Definitionen, die eine moderate Übereinstimmung aufweisen</span> <span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:
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| Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><ref><span style="color: #333333">29. <span class="ve-pasteprotect"><span data-ve-attributes="{"style":"mso-tab-count:1"}" style="box-sizing: inherit"> <span style="box-sizing: inherit"> </span></span></span>Reyes MM, Munigala S, Church EL, Kulik TB, Keyrouz SG, Zipfel GJ, Warren DK: Comparing External Ventricular Drains-Related Ventriculitis Surveillance Definitions. Infect Control Hosp Epidemiol 2017; 38(5):574-579</span></ref><span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:
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| Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:
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| "Times New Roman";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;
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| mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\n\"Times New Roman\";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE"}">. Nachstehend ist die Definition des amerikanischen CDC (Center for Disease Control and Prevention) aufgeführt, die auch in der Leitlinie der IDSA (Infectious Diseases Society of America) verwendet wird</span> <span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:
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| Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><ref name=":0" /><span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:
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| Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:
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| "Times New Roman";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;
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| mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\n\"Times New Roman\";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE"}">.</span>
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| <span class="ve-pasteProtect" style="font-size:12.0pt;
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| mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:Calibri;
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| mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;\nmso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}">Die Diagnose wird gesichert durch eines der folgenden Kriterien</span>
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| *<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\n\"Times New Roman\";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE"}">kultureller Nachweis von Erregern aus dem Liquor</span>
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| ODER
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| *<span class="ve-pasteProtect" style="mso-list:Ignore" data-ve-attributes="{"style":"mso-list:Ignore"}"><span class="ve-pasteProtect" style="font:7.0pt "Times New Roman"" data-ve-attributes="{"style":"font:7.0pt \"Times New Roman\""}"> </span></span>Zwei der folgenden Kriterien:
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| **Fieber > 38,0°C oder Kopfschmerzen
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| **Meningismus
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| **Hirnnervensymptome
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| *und eins der folgenden Kriterien:
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| **<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}">erhöhte Leukozytenzahl, erhöhter Proteingehalt und/oder erniedrigter Glucosegehalt im Liquor</span>
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| **<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}">mikroskopischer Nachweis von Erregern im Liquor</span>
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| **<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}">Nachweis von Erregern im Blut</span>
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| **<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}">positiver IgM-Antikörpertiter oder vierfacher IgG-Titeranstieg für Erreger in wiederholt entnommenen Serumproben</span>
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| ===Diagnostische Schritte===
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| ====<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language: DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\"Times New Roman\";\nmso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:\nDE"}">Basisdiagnostik:</span>====
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| *<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\n\"Times New Roman\";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE"}">Liquorkultur + Grampräparat</span>
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| *<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\n\"Times New Roman\";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE"}">Liquorstatus (Glucose, Laktat, Zellzahl, Granulozyten, Eiweiß)</span>
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| *<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\n\"Times New Roman\";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE"}">Katheterspitze zur mikrobiologischen Diagnostik (nur wenn ein V.a. einen Infekt besteht, nicht routinemäßig)</span>
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| *<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\n\"Times New Roman\";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE"}">Blutkulturen (insb. bei VA-Shunts)</span>
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| *<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\n\"Times New Roman\";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE"}">bei ventrikuloperitonealen Shunts: Abdomen-Sonographie oder CT</span>
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| =====<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language: DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\"Times New Roman\";\nmso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:\nDE"}">Zusatzdiagnostik:</span>=====
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| *<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\n\"Times New Roman\";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE"}">MRT mit Gadolinium, FLAIR, T1- und DWI-Sequenzen</span>
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| *<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\n\"Times New Roman\";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE"}">Procalcitonin im Liquor</span>
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| *<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\n\"Times New Roman\";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE"}">Liquor multiplex-PCR (Panel: H. influenzae. S. agalacticae, E. coli, Meningokokken, S. pneumoniae, L. monocytogenes). Diese Erreger sind häufig bei ambulant aber nicht nosokomial erworbenen Infektionen. </span>
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| *<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\n\"Times New Roman\";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE"}">beta-D-Glucan und Galaktomannan im Liquor bei V.a. eine Pilzinfektion</span>
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| *<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\n\"Times New Roman\";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE"}">Bebrütung der Liquorkulturen für mindestens 10d, um langsamwachsende Erreger, wie z.B. Cutibacterium acnes, nachweisen zu können</span>
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| ===Differentialdiagnosen===
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| *<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\n\"Times New Roman\";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE"}">Hirnabszess</span>
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| *<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;mso-fareast-font-family:\n\"Times New Roman\";mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE"}">sub-/epidurale Empyeme</span>
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| <references />
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