DGI:ZNS-Infektionen/Nosokomiale Ventrikulitis und Meningitis/Diagnostik: Difference between revisions

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<span class="ve-pasteProtect" style="font-size:12.0pt;
<span class="ve-pasteProtect" style="font-size:12.0pt;
mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:Calibri;
mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:Calibri;
mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;\nmso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}">Die Diagnose einer nosokomialen Ventrikulitis bzw. Meningitis ist schwierig </span><span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:
mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;\nmso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}">Die Diagnose einer nosokomialen Ventrikulitis bzw. Meningitis ist schwierig </span><ref name=":0"><span style="color: #333333">28. <span class="ve-pasteprotect"><span data-ve-attributes="{&quot;style&quot;:&quot;mso-tab-count:1&quot;}" 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:
Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}"></span></span><ref name=":0"><span style="color: #333333">28. <span class="ve-pasteprotect"><span data-ve-attributes="{&quot;style&quot;:&quot;mso-tab-count:1&quot;}" 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:&quot;Times New Roman&quot;;mso-bidi-font-family:
Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">]</span></span><span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:
&quot;Times New Roman&quot;;mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;
&quot;Times New Roman&quot;;mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;
mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;mso-fareast-font-family:\n\&quot;Times New Roman\&quot;;mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE&quot;}">. Es gibt verschiedene Definitionen, die eine moderate Übereinstimmung aufweisen</span> <span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:
mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;mso-fareast-font-family:\n\&quot;Times New Roman\&quot;;mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE&quot;}">. Es gibt verschiedene Definitionen, die eine moderate Übereinstimmung aufweisen</span> <ref><span style="color: #333333">29. <span class="ve-pasteprotect"><span data-ve-attributes="{&quot;style&quot;:&quot;mso-tab-count:1&quot;}" 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:
Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}"></span></span><ref><span style="color: #333333">29. <span class="ve-pasteprotect"><span data-ve-attributes="{&quot;style&quot;:&quot;mso-tab-count:1&quot;}" 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:&quot;Times New Roman&quot;;mso-bidi-font-family:
Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}"></span></span><span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:
&quot;Times New Roman&quot;;mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;
&quot;Times New Roman&quot;;mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;
mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;mso-fareast-font-family:\n\&quot;Times New Roman\&quot;;mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE&quot;}">. 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:&quot;Times New Roman&quot;;mso-bidi-font-family:
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Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}"></span></span><span class="ve-pasteProtect" style="font-size:12.0pt;
mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:Calibri;
mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:Calibri;
mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;\nmso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}">Die Diagnose wird gesichert durch eines der folgenden Kriterien</span>
mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;\nmso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}">Die Diagnose wird gesichert durch eines der folgenden Kriterien</span>


*<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family: &quot;Times New Roman&quot;;mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;mso-fareast-font-family:\n\&quot;Times New Roman\&quot;;mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE&quot;}">kultureller Nachweis von Erregern aus dem Liquor</span>
*<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family: &quot;Times New Roman&quot;;mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;mso-fareast-font-family:\n\&quot;Times New Roman\&quot;;mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE&quot;}">Kultureller Nachweis von Erregern aus dem Liquor</span>


ODER
ODER
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**Hirnnervensymptome
**Hirnnervensymptome


*und eins der folgenden Kriterien:
*Und eins der folgenden Kriterien:
**<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}">erhöhte Leukozytenzahl, erhöhter Proteingehalt und/oder erniedrigter Glucosegehalt im Liquor</span>
**<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}">Erhöhte Leukozytenzahl, erhöhter Proteingehalt und/oder erniedrigter Glucosegehalt im Liquor</span>
**<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}">mikroskopischer Nachweis von Erregern im Liquor</span>
**<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}">Mikroskopischer Nachweis von Erregern im Liquor</span>
**<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}">Nachweis von Erregern im Blut</span>
**<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}">Nachweis von Erregern im Blut</span>
**<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}">positiver IgM-Antikörpertiter oder vierfacher IgG-Titeranstieg für Erreger in wiederholt entnommenen Serumproben</span>
**<span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}">Positiver IgM-Antikörpertiter oder vierfacher IgG-Titeranstieg für Erreger in wiederholt entnommenen Serumproben</span>


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Revision as of 09:25, 26 July 2021

Diagnostik

Diagnosekriterien

Die Diagnose einer nosokomialen Ventrikulitis bzw. Meningitis ist schwierig [1]. Es gibt verschiedene Definitionen, die eine moderate Übereinstimmung aufweisen [2]. 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 [1].Die Diagnose wird gesichert durch eines der folgenden Kriterien

  • Kultureller Nachweis von Erregern aus dem Liquor

ODER

  •    Zwei der folgenden Kriterien:
    • Fieber > 38,0°C oder Kopfschmerzen
    • Meningismus
    • Hirnnervensymptome
  • Und eins der folgenden Kriterien:
    • Erhöhte Leukozytenzahl, erhöhter Proteingehalt und/oder erniedrigter Glucosegehalt im Liquor
    • Mikroskopischer Nachweis von Erregern im Liquor
    • Nachweis von Erregern im Blut
    • Positiver IgM-Antikörpertiter oder vierfacher IgG-Titeranstieg für Erreger in wiederholt entnommenen Serumproben


Diagnostische Schritte

Basisdiagnostik:

  • Liquorkultur + Grampräparat
  • Liquorstatus (Glucose, Laktat, Zellzahl, Granulozyten, Eiweiß)
  • Katheterspitze zur mikrobiologischen Diagnostik (nur wenn ein V.a. einen Infekt besteht, nicht routinemäßig)
  • Blutkulturen (insb. bei VA-Shunts)
  • bei ventrikuloperitonealen Shunts: Abdomen-Sonographie oder CT
Zusatzdiagnostik:
  • MRT mit Gadolinium, FLAIR, T1- und DWI-Sequenzen
  • Procalcitonin im Liquor
  • 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.
  • beta-D-Glucan und Galaktomannan im Liquor bei V.a. eine Pilzinfektion
  • Bebrütung der Liquorkulturen für mindestens 10d, um langsamwachsende Erreger, wie z.B. Cutibacterium acnes, nachweisen zu können


Differentialdiagnosen

  • Hirnabszess
  • sub-/epidurale Empyeme
  1. ↑ 1.0 1.1 28.            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
  2. ↑ 29.            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
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