Comparison of patient characteristics, clinical management, infectious specialist consultation, and outcome in men and women with methicillin-sensitive Staphylococcus aureus bacteremia: a propensity-score adjusted retrospective study

• Published in: Infection 2018-12, Vol.46 (6), p.837-845
• Main Authors: Forsblom, E., Kakriainen, A., Ruotsalainen, E., Järvinen, A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Alcoholism; Anti-Bacterial Agents - therapeutic use; Antibiotics; Bacteremia; Bacteremia - drug therapy; Consultation; Drug abuse; Echocardiography; Esophagus; Family Medicine; Female; Finland; General Practice; Hospitals; Humans; Infectious Diseases; Internal Medicine; Laboratory tests; Male; Management; Medical prognosis; Medicine; Medicine & Public Health; Men; Mens health; Methicillin; Methicillin - therapeutic use; Middle Aged; Mortality; Nosocomial infection; Original Paper; Patients; Propensity Score; Referral and Consultation - statistics & numerical data; Retrospective Studies; Rifampin; Sex; Sex differences; Staphylococcal Infections - drug therapy; Staphylococcus aureus; Staphylococcus aureus - physiology; Thromboembolism; Treatment Outcome; Women; Womens health
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-018-1216-3

Background Sex-related treatment inequalities are suggested to explain outcome differences between men and women in Staphylococcus aureus bacteremia (SAB). We compared patient characteristics, clinical management, infectious specialist consultation (ISC) and outcome in men and women with SAB. Methods Multicenter retrospective study of methicillin-sensitive (MS-) SAB patients categorized according to sex and ISC consultation provided within 7 days of diagnosis. Results Altogether 617 SAB patients were included in the analysis: 62% males and 38% females. Male sex was associated less often to nosocomial bacteremia (OR 0.69, 95% CI 0.50–0.96, p  = 0.029) and more often to alcoholism (OR 2.25, 95% CI 1.31–3.87, p  = 0.003). No sex-related differences were seen in basic or immunologic laboratory tests, illness severity, intensive care unit treatment or thromboembolic events. ISC was provided to most patients (94%) irrespective of sex. No differences were seen in clinical management of men or women: Transthoracic or -esophageal echocardiography (61% vs. 65%), deep infection (77% vs. 72%), infection removal (30% vs. 27%) and anti-staphylococcal antibiotics as first-line treatment (54% vs. 51%). However, male sex was connected to more frequent adjunctive rifampicin treatment (52% vs. 41%, p  = 0.025). No difference in 28- or 90-day mortality (13% vs. 13% and 18% vs. 20%) or SAB relapse (0% vs. 1%) was observed between men and women. Propensity-score adjusted Cox proportional analysis gave no connection of sex to mortality within 90 days. Conclusion Patient characteristics, clinical management, ISC guidance, bacteremia relapse, and outcome did not differ in men and women with MS-SAB.