Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Microbiol Spectr. 2022 Feb 23;10(1):e0146221. doi: 10.1128/spectrum.01462-21. Epub 2022 Feb 9.
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. 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.
凝固酶阴性葡萄球菌（CoNS）是与医疗保健相关的脑室炎和脑膜炎（HCAVM）的主要病原体。本研究旨在评估抗菌药物敏感性。此外，还描述了治疗和临床结果。2012 年至 2020 年，在中国最大的神经外科中心之一，所有接受神经外科治疗的成年人，如果从脑脊液培养物中分离出具有临床意义的凝固酶阴性葡萄球菌，都被招募入组。一个发作定义为一个患者有一个细菌株。根据 MIC 应用解释类别。临床结果分为差（格拉斯哥结局量表 1 至 3）和可接受（格拉斯哥结局量表 4 至 5）。共分析了 534 例涉及 519 例患者和 16 株细菌的发作。9 年来，共进行了 8 种抗菌药物的药敏试验，其中 6 种药物在超过 80%的凝固酶阴性葡萄球菌中使用。耐药率范围为 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（万古霉素替代品）耐药率为 3.1%。耐苯唑西林（代表耐甲氧西林葡萄球菌）的凝固酶阴性葡萄球菌率为 70.2%。任何分析药物在 9 年内都没有出现抗菌药物敏感性的显著趋势。然而，确实存在一些明显的变化。值得注意的是，近年来出现了万古霉素耐药性凝固酶阴性葡萄球菌，而利奈唑胺耐药性凝固酶阴性葡萄球菌很早就出现了，近年来已经消失。万古霉素（或去甲万古霉素）是最常用的治疗药物，在 528 例（98.9%）发作中使用。最后，527 例（98.7%）的结果是可接受的。在不久的将来，使用万古霉素治疗凝固酶阴性葡萄球菌相关的 HCAVM 将是安全的，尽管需要进行持续监测。凝固酶阴性葡萄球菌是与医疗保健相关的脑室炎和脑膜炎的主要病原体。从本研究的结果得出三个结论。首先，根据抗菌药物敏感性，对主要抗菌药物的耐药率较高，对高水平药物（包括万古霉素）的耐药率较低。其次，耐药率趋势是可以接受的，特别是对于高水平的药物，尽管需要长期和持续的监测。最后，万古霉素治疗神经外科成人凝固酶阴性葡萄球菌相关的与医疗保健相关的脑室炎和脑膜炎的临床结果是可以接受的。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与医疗保健相关的脑室炎和脑膜炎将是安全的。
