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Abstract：
Coagulase-negative staphylococci (CoNS) are the main pathogens in health care-associated ventriculitis and meningitis (HCAVM). This study aimed to assess antimicrobial susceptibility. Moreover, the treatment and clinical outcome were described. All neurosurgical adults admitted to one of the largest neurosurgical centers in China with clinically significant CoNS isolated from cerebrospinal fluid cultures in 2012 to 2020 were recruited. One episode was defined as one patient with one bacterial strain. Interpretive categories were applied according to the MICs. The clinical outcomes were dichotomized into poor (Glasgow Outcome Scale 1 to 3) and acceptable (Glasgow Outcome Scale 4 to 5). In total, 534 episodes involving 519 patients and 16 bacteria were analyzed. Over the 9 years, eight antimicrobial agents were used in antimicrobial susceptibility tests, including six in over 80% of CoNS. The range of resistance rates was 0.8% to 84.6%. The vancomycin resistance rate was the lowest, whereas the penicillin resistance rate was the highest. The linezolid (a vancomycin replacement) resistance rate was 3.1%. The rate of oxacillin resistance, representing methicillin-resistant staphylococci, was 70.2%. There were no significant trends of antimicrobial susceptibility over the 9 years for any agents analyzed. However, there were some apparent changes. Notably, vancomycin-resistant CoNS appeared in recent years, while linezolid-resistant CoNS appeared early and disappeared in recent years. Vancomycin (or norvancomycin), the most common treatment agent, was used in 528 (98.9%) episodes. Finally, 527 (98.7%) episodes had acceptable outcomes. It will be safe to use vancomycin to treat CoNS-related HCAVM in the immediate future, although continuous monitoring will be needed. IMPORTANCE Coagulase-negative staphylococci are the main pathogens in health care-associated ventriculitis and meningitis. There are three conclusions from the results of this study. First, according to antimicrobial susceptibility, the rates of resistance to primary antimicrobial agents are high and those to high-level agents, including vancomycin, are low. Second, the trends of resistance rates are acceptable, especially for high-level agents, although long-term and continuous monitoring is necessary. Finally, the clinical outcomes of neurosurgical adults with coagulase-negative staphylococci-related health care-associated ventriculitis and meningitis are acceptable after treatment with vancomycin. Therefore, according to the antimicrobial susceptibility and clinical practice, vancomycin will be safe to treat coagulase-negative staphylococci-related health care-associated ventriculitis and meningitis.
摘要：
凝固酶阴性葡萄球菌（CoNS）是卫生保健相关脑室炎和脑膜炎（HCAVM）的主要病原体。本研究旨在评估抗菌药物敏感性。此外，描述了治疗和临床结果。招募了2012年至2020年从脑脊液培养物中分离出具有临床意义的CoNS的中国最大神经外科中心之一的所有神经外科成人。一次发作被定义为一名患者患有一种细菌菌株。解释性类别根据中等收入国家应用。临床结果分为差（格拉斯哥结果量表1至3）和可接受（格拉斯哥结果量表4至5）。总的来说,分析涉及519例患者和16例细菌的534例发作。在过去的9年里,八种抗菌药物用于抗菌药物敏感性试验，包括超过80%的CoNS中的六个。电阻率的范围为0.8%至84.6%。万古霉素耐药率最低,而青霉素耐药率最高。利奈唑胺（万古霉素替代药）耐药率为3.1%。苯唑西林耐药率，代表耐甲氧西林葡萄球菌，为70.2%。对于所分析的任何药剂,在9年中没有抗微生物剂敏感性的显著趋势。然而,有一些明显的变化。值得注意的是,近年来出现了耐万古霉素的CoNS,而耐利奈唑胺的CoNS出现较早，近年来消失。万古霉素（或去甲万古霉素），最常见的治疗剂，用于528次（98.9%）发作。最后,527（98.7%）次发作具有可接受的结果。在不久的将来，使用万古霉素治疗CoNS相关的HCAVM将是安全的，虽然需要持续监测。重要性凝固酶阴性葡萄球菌是卫生保健相关脑室炎和脑膜炎的主要病原体。本研讨的成果得出了三个结论。首先,根据抗菌药物敏感性，对主要抗菌药物的耐药率很高，对高水平药物的耐药率很高，包括万古霉素,很低。第二,阻力率的趋势是可以接受的，特别是对于高级特工，虽然长期和持续的监测是必要的。最后,在接受万古霉素治疗后,患有凝固酶阴性葡萄球菌相关卫生保健相关脑室炎和脑膜炎的神经外科成人患者的临床结局是可以接受的.因此,根据抗菌药物敏感性和临床实践，万古霉素治疗凝固酶阴性葡萄球菌相关的卫生保健相关脑室炎和脑膜炎是安全的。
