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Der Seiteninhalt wurde durch einen anderen Text ersetzt: „== Diagnostik == {{DGI:Nosokomiale Ventrikulitis und Meningitis/Diagnostik/Diagnosekriterien}} {{DGI:Nosokomiale Ventrikulitis und…“
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==Diagnostik==
== Diagnostik ==


===Diagnosekriterien===
{{DGI:Nosokomiale Ventrikulitis und Meningitis/Diagnostik/Diagnosekriterien}}
<span class="ve-pasteProtect" style="font-size:12.0pt;
{{DGI:Nosokomiale Ventrikulitis und Meningitis/Diagnostik/Diagnostische_Schritte}}
mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:Calibri;
{{DGI:Nosokomiale Ventrikulitis und Meningitis/Diagnostik/Dfferentialdiagnosen}}
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:
&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> <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:\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> <ref name=":0" /><span class="ve-pasteProtect" style="font-size:12.0pt;mso-fareast-font-family:
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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;}">.</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;}"><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;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;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;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;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;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>
 
ODER
 
*<span class="ve-pasteProtect" style="mso-list:Ignore" data-ve-attributes="{&quot;style&quot;:&quot;mso-list:Ignore&quot;}"><span class="ve-pasteProtect" style="font:7.0pt &quot;Times New Roman&quot;" data-ve-attributes="{&quot;style&quot;:&quot;font:7.0pt \&quot;Times New Roman\&quot;&quot;}">   </span></span>Zwei der folgenden Kriterien:
**Fieber > 38,0°C oder Kopfschmerzen
**Meningismus
**Hirnnervensymptome
 
*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;}">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;}">Positiver IgM-Antikörpertiter oder vierfacher IgG-Titeranstieg für Erreger in wiederholt entnommenen Serumproben</span>
 
<br />
 
===Diagnostische Schritte===
 
====<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;;\nmso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:\nDE&quot;}">Basisdiagnostik:</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;}">Liquorkultur + Grampräparat</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;}">Liquorstatus (Glucose, Laktat, Zellzahl, Granulozyten, Eiweiß)</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;}">Katheterspitze zur mikrobiologischen Diagnostik (nur wenn ein V.a. einen Infekt besteht, nicht routinemäßig)</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;}">Blutkulturen (insb. bei VA-Shunts)</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;}">Bei ventrikuloperitonealen Shunts: Abdomen-Sonographie oder CT</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;;\nmso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:\nDE&quot;}">Zusatzdiagnostik:</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;}">MRT mit Gadolinium, FLAIR, T1- und DWI-Sequenzen</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;}">Procalcitonin 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:\n\&quot;Times New Roman\&quot;;mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;\nmso-ansi-language:DE&quot;}">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>
*<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;}">Beta-D-Glucan und Galaktomannan im Liquor bei V.a. eine Pilzinfektion</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;}">Bebrütung der Liquorkulturen für mindestens 10d, um langsamwachsende Erreger, wie z.B. ''Cutibacterium acnes'', nachweisen zu können</span>
 
<br />
 
===Differentialdiagnosen===
 
*<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;}">Hirnabszess</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;}">Sub-/epidurale Empyeme</span>
<references />

Version vom 31. Juli 2021, 09:10 Uhr

Diagnostik

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

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

DGI:Nosokomiale Ventrikulitis und Meningitis/Diagnostik/Dfferentialdiagnosen

  1. ↑ 1,0 1,1  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. ↑ 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
Abgerufen von „https://wiki.cakele.iodatalabs.dev/w/index.php?title=DGI:ZNS-Infektionen/Nosokomiale_Ventrikulitis_und_Meningitis/Diagnostik&oldid=2518“