Enterococci-related healthcare-associated ventriculitis and meningitis: a multicenter retrospective case series from clinical practice

Healthcare-associated ventriculitis and meningitis (HCAVM) is a severe infection and is associated with high morbidity, mortality, and poor functional prognosis, and the associated microorganisms can be skin flora or nosocomial pathogens, most commonly Gram-negative bacteria. Enterococci-related HCAVM have rarely been discussed systemically, the related drug resistance and outcomes have been poorly researched. In this multicenter retrospective case series, we analyzed patients with Enterococci-related HCAVM from three tertiary hospitals. Our study assessed bacterial resistance patterns, antimicrobial treatment strategies, and clinical outcomes in this patient cohort. A total of 94 strains of Enterococci causing HCAVM were identified, including 58 strains of Enterococcus faecalis and 34 strains of Enterococcus faecium. Vancomycin resistance rate was 7.4%(7/94), which only occurred in E. faecium. The linezolid resistance rate was 1.1%(1/94). Ten tested antimicrobial agents showed higher resistance rates against E. faecium than against E. faecalis. Vancomycin was used in 88 patients as empirical treatment, which was changed to linezolid in 12 patients, including those with vancomycin-resistant E. faecium. Four (4.3%) patients experienced ineffective treatments, eight (8.5%) had poor outcomes, and the treatment course was 15.3 ± 10.9 days. In conclusion, our findings reveal the different resistance rates of Enterococcus faecalis and Enterococcus faecium to vancomycin and linezolid, reveal the clinical epidemiological characteristics of Enterococci-related HCAVM, and provide an important reference for the selection of antimicrobial agents.