title: Gender differences in the outcome of community-acquired Staphylococcus aureus bacteraemia: a historical population-based cohort study.
abstract: OBJECTIVE
  Female gender has been suggested to be associated with poor outcome in patients with Staphylococcus aureus bacteraemia (SAB), but existing data remain sparse and conflicting. We investigated clinical outcomes in female and male patients with community-acquired (CA-) SAB.
  
  
  METHODS
  Population-based medical registers were used to conduct a cohort study of all adult patients with CA-SAB in northern Denmark, 2000-2011. Thirty-day mortality after CA-SAB for female and male patients was estimated by the Kaplan-Meier method. Using Cox proportional hazards regression, we computed hazard ratios (HRs) of death according to gender, overall and stratified by age groups, co-morbidity level, and selected major diseases while adjusting for potential confounders. Moreover, we estimated 30-day prevalence proportions for SAB-associated infective endocarditis and osteomyelitis by gender.
  
  
  RESULTS
  Among 2638 patients with CA-SAB, 1022 (39%) were female. Thirty-day mortality was 29% (n = 297) in female patients and 22% (n = 355) in male patients, yielding an adjusted HR (aHR) of 1.30 (95% CI, 1.11-1.53). This association appeared robust across age groups, whereas no consistent pattern was observed according to co-morbidity level. Compared with male patients, the prognostic impact of gender was most pronounced among female patients with diabetes (aHR 1.52; 95% CI 1.04-2.21)), and among female patients with cancer (aHR 1.40; 95% CI 1.04-1.90). The 30-day prevalence of infective endocarditis or osteomyelitis did not differ according to gender.
  
  
  CONCLUSIONS
  Female patients with CA-SAB experienced increased 30-day mortality compared with male patients. Gender should be considered in the triage and risk stratification of CA-SAB patients.
authors.affiliation: Department of Clinical Microbiology, Aalborg University Hospital, Denmark; Department of Infectious Diseases, Aalborg University Hospital, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Denmark. Electronic address: jesm@rn.dk.
authors.forename: J
authors.initials: J
authors.lastname: Smit
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain.
authors.forename: L E
authors.initials: LE
authors.lastname: López-Cortés
authors.affiliation: Institute of Medical Microbiology and Hospital Hygiene, Heinrich Heine University, Düsseldorf, Germany.
authors.forename: A J
authors.initials: AJ
authors.lastname: Kaasch
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Søgaard
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.
authors.forename: R W
authors.initials: RW
authors.lastname: Thomsen
authors.affiliation: Department of Clinical Microbiology, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark.
authors.forename: H C
authors.initials: HC
authors.lastname: Schønheyder
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain; Facultad de Medicina, Universidad de Sevilla, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Rodríguez-Baño
authors.affiliation: Department of Infectious Diseases, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Nielsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012727:Sex Characteristics; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D013211:Staphylococcus aureus; D055815:Young Adult
keywords: Cohort study; Epidemiological study; Gender; Outcome; Prognosis; S. aureus bacteraemia; Sex