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Women face increased CA-S. aureus bacteremia mortality
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Community-acquired Staphylococcus aureus bacteremia mortality appeared to be more frequent in females than males, according to a recently published population study.
This difference was especially pronounced among female patients with diabetes or cancer, Jesper Smit, MD, of the clinical microbiology, infectious diseases departments at Aalborg University Hospital, Denmark, and colleagues wrote. However, the 30-day prevalence of infective endocarditis or osteomyelitis appeared similar between genders.
“Gender may influence the outcome in patients with [S. aureus bacteremia (SAB)] due to differences in hormonal and cell-mediated immune responses between female and male patients or through gender-related differences in the distribution of age and underlying diseases,” the researchers wrote. “Comprehensive data elucidating the prognostic influence of gender in patients with SAB may increase our understanding of the clinical course of patients with SAB, help define high-risk groups for optimized patient triage, and potentially contribute to improved clinical care for SAB patients.”
Smit and colleagues examined culture-confirmed, community-acquired (CA)-SAB cases within the Danish population recorded from 2000 to 2011. Using data from the Danish National Patient Registry, they reviewed cases’ demographics, treatments and comorbidities and clinical outcomes to identify factors in male and female patients’ clinical outcomes.
Among the 2,638 Danish CA-SAB patients, 61.3% were male. Female patients were more frequently older than males (median, 71.1 years vs. 67.9 years) and slightly more likely to be sub-categorized as a health care-associated case (44.2% vs. 41%). MRSA was rare overall, and hospital-diagnosed comorbidity rates were similar between men and women.
The researchers observed 30-day cumulative mortality rates of 29.1% among female patients and 22% among males, which translated to an adjusted HR of 1.3 (95% CI, 1.11-1.53). This estimated risk increase appeared robust across several age groups, but was weakest for those aged 15 to 39 years. The influence of female gender was substantially greater among patients with diabetes (adjusted HR = 1.52; 95% CI, 1.03-2.21) or cancer (aHR = 1.4; 95% CI, 1.04-1.9), but only slightly increased with chronic pulmonary disease (aHR = 1.36; 95% CI, 0.93-1.99). There were no gender-associated differences in infective endocarditis or osteomyelitis rates.
These findings add additional evidence of gender’s impact on CA-SAB, which has been at odds with conflicting data from other studies, the researchers wrote. However, the underlying cause of this trend is still unclear, they continued, and is in need of further investigation.
“Our study provides evidence that female gender is associated with increased 30-day mortality in patients with CA-SAB,” Smit and colleagues wrote. “Further studies exploring mechanisms underlying this gender dimorphism are needed, and female gender should be considered a key element in the triage and risk stratification of patients with CA-SAB.” – by Dave Muoio
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Jodi Lindsay
A new study shows convincing data that women have a higher 30-day mortality due to community-associated S. aureus bacteremia (CA-SAB) than men (29.1% v 22%). The study is powerful and based on 2,638 cases in Denmark, where MRSA is low. The findings are consistent with some previous large-scale studies and hold across age groups and with comorbidities such as diabetes, chronic pulmonary disease and cancer. Female gender may be considered a risk factor for early mortality in diagnosed patients. The mechanism of increased mortality is unknown, and we can only speculate on why there should be a gender difference. The difference is convincing enough to be a priority research area for experimental studies.
Disclosure: Lindsay reports no relevant financial disclosures.
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