, Volume 46, Issue 6, pp 837–845 | Cite as

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

  • E. ForsblomEmail author
  • A. Kakriainen
  • E. Ruotsalainen
  • A. Järvinen
Original Paper



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.


Multicenter retrospective study of methicillin-sensitive (MS-) SAB patients categorized according to sex and ISC consultation provided within 7 days of diagnosis.


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.


Patient characteristics, clinical management, ISC guidance, bacteremia relapse, and outcome did not differ in men and women with MS-SAB.


S. aureus bacteremia Infectious specialist consultation Deep infection foci Prognosis Sex 



The study has been supported by grants from The Medical Society of Finland, the Perkléns Foundation and the Maud Kuistila Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest. On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethics statement

The trial was approved by the institutional review board of Helsinki University Central Hospital and the ethical committee of Helsinki University Central Hospital.


  1. 1.
    Braquet P, Alla F, Cornu C, et al. Factors associated with 12 week case-fatality in Staphylococcus aureus bacteraemia: a prospective cohort study. Clin Microbiol Infect. 2016;22:948.e1–948.e7.CrossRefGoogle Scholar
  2. 2.
    Kang CI, Song JH, Ko KS, et al. Asian Network for Surveillance of Resistant Pathogens Study Group. Clinical features and outcome of Staphylococcus aureus infection in elderly versus younger adult patients. Int J Infect Dis. 2011;15:58–62.CrossRefGoogle Scholar
  3. 3.
    Ammerlaan H, Seifert H, Harbarth S, et al. Adequacy of antimicrobial treatment and outcome 334 of Staphylococcus aureus bacteremia in 9 Western European countries. Clin Infect Dis. 2009;49:997–1005.CrossRefGoogle Scholar
  4. 4.
    Rieg S, Peyerl-Hoffmann G, de With K, et al. Mortality of S. aureus bacteremia and infectious diseases specialist consultation—a study of 521 patients in Germany. J Infect. 2009;59:232–9.CrossRefGoogle Scholar
  5. 5.
    Cosgrove S, Sakoulas G, Perencevich E, et al. Comparison of mortality associated with methicillin resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis. 2003;36:53–9.CrossRefGoogle Scholar
  6. 6.
    Honda H, Krauss M, Jones J, et al. The value of infectious diseases consultation in Staphylococcus aureus bacteremia. Am J Med. 2010;123:631–7.CrossRefGoogle Scholar
  7. 7.
    Saunderson R, Gouliouris T, Nickerson E, et al. Impact of routine bedside infectious disease consultation on clinical management and outcome of Staphylococcus aureus bacteraemia in adults. Clin Microbiol Infect. 2015;21:779–85.CrossRefGoogle Scholar
  8. 8.
    Martin L, Harris M, Brooks A, et al. Management and outcomes in patients with Staphylococcus aureus bacteremia after implementation of mandatory infectious diseases consult: a before/after study. BMC Infect Dis. 2015;15:568.CrossRefGoogle Scholar
  9. 9.
    Adrie C, Azoulay E, Francais A, et al. Influence of gender on the outcome of severe sepsis: a reappraisal. Chest. 2007;132:1786–93.CrossRefGoogle Scholar
  10. 10.
    Leibovici L, Paul M, Weinberger M, et al. Excess mortality in women with hospital-acquired bloodstream infection. Am J Med. 2001;111:120–5.CrossRefGoogle Scholar
  11. 11.
    Madsen T, Simmons J, Choo E, et al. The disparity study: Do gender differences exist in surviving sepsis campaign resuscitation bundle completion, completion of individual bundle elements, or sepsis mortality? J Crit Care. 2014;29:473 7–11.CrossRefGoogle Scholar
  12. 12.
    Mejer N, Westh H, Schønheyder HC, et al. Stable incidence and continued improvement in the short term mortality of Staphylococcus aureus bacteremia between 1995–2008. BMC Infect Dis. 2012;12:260.CrossRefGoogle Scholar
  13. 13.
    Smit J, Lopez-Cortes LE, Kaasch AJ, et al. Gender differences in the outcome of community-acquired Staphylococcus aureus bacteraemia: a historical population-based cohort study. Clin Microbiol Infect. 2017;23:27–32.CrossRefGoogle Scholar
  14. 14.
    Lamagni T, Potz N, Powell D, et al. Mortality in patients with meticillin-resistant Staphylococcus aureus bacteraemia, England 2004–2005. J Hosp Infect. 2011;77:16–20.CrossRefGoogle Scholar
  15. 15.
    Allard C, Carignan A, Bergevin M, et al. Secular changes in incidence and mortality associated with Staphylococcus aureus bacteraemia in Quebec, Canada, 1991–2005. Clin Microbiol Infect. 2008;14:421–8.CrossRefGoogle Scholar
  16. 16.
    Mansur N, Hazzan R, Paul M, et al. Does sex affect 30-day mortality in Staphylococcus aureus bacteremia. Gender Med. 2012;9:463–70.CrossRefGoogle Scholar
  17. 17.
    Yahav D, Yassin S, Shaked H, et al. Risk factors for long-term mortality of Staphylococcus aureus bacteremia. Eur J Clin Microbiol Infect Dis. 2016;35:785–90.CrossRefGoogle Scholar
  18. 18.
    Humphreys H, Fitzpatrick F, Harvey BJ. Gender differences in rates of carriage and bloodstream infection caused by methicillin-resistant Staphylococcus aureus: are they real, do they matter and why? Clin Infect Dis. 2015;61:1708–14.PubMedGoogle Scholar
  19. 19.
    Angele MK, Pratschke S, Hubbard WJ, et al. Gender difference in sepsis: cardiovascular and immunological aspects. Virulence. 2014;5:12–9.CrossRefGoogle Scholar
  20. 20.
    Schroder W, Sommer H, Gladstone BP, et al. Gender differences in antibiotic prescribing in the community: a systematic review and meta-analysis. J Antimicrob Chemother. 2016;71:1800–6.CrossRefGoogle Scholar
  21. 21.
    Madsen TE, Napoli AM. The disparity-ii study: delays to antibiotic administration in women with severe sepsis or septic shock. Acad Emerg Med. 2014;21:1499–502.CrossRefGoogle Scholar
  22. 22.
    Pietropaoli AP, Glance LG, Oakes D, et al. Gender differences in mortality in patients with severe sepsis or septic shock. Gender Med. 2010;7:422–37.CrossRefGoogle Scholar
  23. 23.
    Raine R, Goldfrad C, Rowan K, et al. Influence of patient gender on admission to intensive care. J Epidemiol Community Health. 2002;56:418–23.CrossRefGoogle Scholar
  24. 24.
    Ruotsalainen E, Järvinen A, Koivula I, et al. Levofloxacin does not decrease mortality in Staphylococcus aureus bacteraemia when added to the standard treatment: a prospective and randomized clinical trial of 381 patients. J Intern Med. 2006;259:179–90.CrossRefGoogle Scholar
  25. 25.
    Tacconelli E, Foschi F. Does gender affect the outcome of community-acquired Staphylococcus aureus bacteraemia? Clin Microbiol Infect. 2017;23:23–5.CrossRefGoogle Scholar
  26. 26.
    McCabe WR, Jackson GG. Gram-negative bacteremia: I. Etiology and ecology. Arch Intern Med. 1962;110:847–55.CrossRefGoogle Scholar
  27. 27.
    Forsblom E, Ruotsalainen E, Ollgren J, et al. Telephone consultation cannot replace bedside infectious disease consultation in the management of Staphylococcus aureus bacteraemia. Clin Infect Dis. 2012;56:527–35.CrossRefGoogle Scholar
  28. 28.
    Thwaites GE, Scarborough M, Szubert A, et al. Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 2018;17:668–78.CrossRefGoogle Scholar
  29. 29.
    Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika. 1983;70:41–55.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Infectious Diseases, Department of Medicine, Inflammation Center, Helsinki University Central Hospital, Aurora HospitalUniversity of HelsinkiHelsinkiFinland

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