Comparative analysis of post-neurosurgical intracranial infections: distinct clinical-laboratory profile of coagulase-negative staphylococci versus other bacterial pathogens

Coagulase-negative staphylococci (CoNS) are prevalent yet diagnostically challenging pathogens in postoperative intracranial infections. Their distinct clinical presentation compared to other bacterial causes remains poorly characterized. In this single-center retrospective cohort study (2010–2020), we compared adult patients with microbiologically confirmed post-neurosurgical intracranial infection caused solely by CoNS ( n = 102) versus other bacterial pathogens ( n = 256). We employed stringent criteria to define true CoNS infection. Clinical features, laboratory parameters, and outcomes were compared. Multivariable logistic regression and LASSO analysis were used to identify factors associated with CoNS etiology. The CoNS group exhibited a significantly lower incidence of severe clinical symptoms, including headache (64.7% vs. 84.0%, p < 0.001), vomiting (52.9% vs. 69.9%, p = 0.003), and intracranial hypertension (18.6% vs. 32.0%, p = 0.011). Paradoxically, they demonstrated markedly higher systemic and cerebrospinal fluid inflammatory markers (peripheral WBC, CRP, CSF WBC and albumin, all p < 0.001). Multivariable analysis identified higher body temperature (aOR = 2.85 per 1 °C), lower postoperative hemoglobin (aOR = 1.32 per 1 g/dL decrease), external CSF drainage (aOR = 3.01), longer operation time, clean wound classification, and postoperative CSF leakage as independently associated with CoNS infection. Thirty‑day mortality was extremely low and comparable between groups (0% vs. 0.4%, p = 1.00), as was 1‑year mortality (1.0% vs. 0.8%, p = 0.85). Post-neurosurgical CoNS intracranial infections present a unique clinical-laboratory profile characterized by less severe symptoms but a more pronounced inflammatory response compared to other bacterial infections. This dissociation, potentially biofilm-mediated, warrants clinical vigilance. The identified associated factors may aid in early suspicion and diagnostic stratification.