Abstract: OBJECTIVE To investigate the factors affecting intracranial infection after neurosurgery and the changes of cerebrospinal fluid procalcitonin (PCT), white blood cell count (WBC) and CXC chemokine ligand 10 (CXCL10) and their diagnostic value. METHODS Totally 81 patients with intracranial infection after neurosurgery treated in The Fifth Affiliated Hospital of Xinjiang Medical University between Mar. 2016 and Apr. 2021 were selected as the infection group, and 73 patients without intracranial infection after neurosurgery treated during the same period were selected as the non-infection group. The culture of cerebrospinal fluid pathogenic bacteria in the infection group was analyzed. Multivariate Logistic regression analysis was used to summarize the influencing factors of postoperative intracranial infection in patients undergoing neurosurgery. The differential diagnostic efficiency of PCT, CXCL10 and WBC on intracranial infection after neurosurgery was analyzed. RESULTS A total of 81 strains of pathogenic bacteria were isolated and cultured from cerebrospinal fluid, among which 47 strains of Gram-positive bacteria accounted for 58.02%, mainly coagulase negative Staphylococcus and Staphylococcus aureus, and 34 strains of Gram-negative bacteria accounted for 41.98%, mainly Acinetobacter baumannii and Klebsiella pneumoniae. The levels of PCT, CXCL10 and WBC in the cerebrospinal fluid of the infection group were higher than those of the non-infection group (P<0.05). External ventricular drainage, occurrence of cerebrospinal fluid leakage and PCT, CXCL10 and WBC were the influencing factors of postoperative intracranial infection in patients undergoing neurosurgery (P<0.05). The levels of PCT, CXCL10 and WBC in the cerebrospinal fluid of patients with intracranial infection of Gram-positive bacteria were lower than those of patients with Gram-negative bacteria infection (P<0.05). Receiver operating characteristic (ROC) curve results showed that cerebrospinal fluid PCT, CXCL10 and WBC had high efficiency in guiding the identification of intracranial infection, and also had high efficiency in distinguishing Gram-positive and gram-negative bacterial intracranial infections in patients after neurosurgery. Among them, PCT had a more obvious discriminatory value for differentiating Gram-positive bacteria from gram-negative bacterial intracranial infections, with a Youden index of 0.624, corresponding cut-off value of 1.85 μg/L, an area under the curve (AUC) of 0.807, and a sensitivity and specificity of 82.98% and 79.41%, respectively. CONCLUSION External ventricular drainage, occurrence of cerebrospinal fluid leakage, as well as abnormally high expressions of PCT, CXCL10 and WBC were all influencing factors in the development of intracranial infections in patients after neurosurgery. In addition, PCT, CXCL10 and WBC in the cerebrospinal fluid of patients with intracranial infection after neurosurgery had high guiding efficiency in distinguishing different pathogenic bacteria.