Microbiological Spectrum and Antimicrobial Resistance Patterns of Cerebrospinal Fluid Isolates from Neurosurgical...

Background/Objectives: Central nervous system (CNS) infections in neurosurgical patients remain a serious cause of morbidity and mortality, particularly in healthcare-associated settings. The microbiological profile and antimicrobial resistance patterns of these infections vary between institutions and regions. This study aimed to evaluate the distribution of cerebrospinal fluid (CSF) pathogens and their antimicrobial susceptibility profiles in neurosurgical patients treated at a tertiary care hospital in Hatay, Türkiye. Methods: This retrospective cross-sectional study included 447 patients with CSF culture and antimicrobial susceptibility results obtained between January 2015 and June 2025. Results: Overall, 17.2% of patients had positive CSF cultures, with significantly higher positivity in intensive care unit (ICU) patients compared with ward patients (30.2% vs. 12.7%, p < 0.001). The most frequently isolated pathogens were Acinetobacter baumannii, coagulase-negative staphylococci, and Klebsiella pneumoniae. Gram-negative organisms were more common in ICU patients (70.2%), whereas Gram-positive organisms predominated in ward patients (62.5%) (p = 0.001). No significant association was found between primary neurosurgical diagnosis and specific bacterial species (p > 0.05). However, Gram-negative predominance was observed in intracranial mass cases, while hydrocephalus was mainly associated with Gram-positive organisms. High antimicrobial resistance rates were observed among Gram-negative isolates, including carbapenem resistance (40.9%) and amikacin resistance (45.5%). Glycopeptides displayed activity against all Gram-positive isolates. Conclusions: The findings of this study support the importance of updated antimicrobial stewardship and further prospective multicenter studies to improve infection management in neurocritical care settings.