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Meta-Analysis
. 2024 Feb 5;7(2):e240473.
doi: 10.1001/jamanetworkopen.2024.0473.

Female Sex and Mortality in Patients with Staphylococcus aureus Bacteremia: A Systematic Review and Meta-analysis

Annette C Westgeest  1   2 , Merel M C Lambregts  2 , Felicia Ruffin  1 , Rachel E Korn  1 , Maren E Webster  1 , Jackson L Kair  1 , Joshua B Parsons  1 , Stacey A Maskarinec  1 , Samantha Kaplan  3 , Olaf M Dekkers  4 , Mark G J de Boer  2   4 , Vance G Fowler Jr  1   5 , Joshua T Thaden  1
Affiliations
Meta-Analysis

Female Sex and Mortality in Patients with Staphylococcus aureus Bacteremia: A Systematic Review and Meta-analysis

Annette C Westgeest et al. JAMA Netw Open. .

Abstract

Importance: Staphylococcus aureus is the leading cause of death due to bacterial bloodstream infection. Female sex has been identified as a risk factor for mortality in S aureus bacteremia (SAB) in some studies, but not in others.

Objective: To determine whether female sex is associated with increased mortality risk in SAB.

Data sources: MEDLINE, Embase, and Web of Science were searched from inception to April 26, 2023.

Study selection: Included studies met the following criteria: (1) randomized or observational studies evaluating adults with SAB, (2) included 200 or more patients, (3) reported mortality at or before 90 days following SAB, and (4) reported mortality stratified by sex. Studies on specific subpopulations (eg, dialysis, intensive care units, cancer patients) and studies that included patients with bacteremia by various microorganisms that did not report SAB-specific data were excluded.

Data extraction and synthesis: Data extraction and quality assessment were performed by 1 reviewer and verified by a second reviewer. Risk of bias and quality were assessed with the Newcastle-Ottawa Quality Assessment Scale. Mortality data were combined as odds ratios (ORs).

Main outcome and measures: Mortality at or before 90-day following SAB, stratified by sex.

Results: From 5339 studies retrieved, 89 were included (132 582 patients; 50 258 female [37.9%], 82 324 male [62.1%]). Unadjusted mortality data were available from 81 studies (109 828 patients) and showed increased mortality in female patients compared with male patients (pooled OR, 1.12; 95% CI, 1.06-1.18). Adjusted mortality data accounting for additional patient characteristics and treatment variables were available from 32 studies (95 469 patients) and revealed a similarly increased mortality risk in female relative to male patients (pooled adjusted OR, 1.18; 95% CI, 1.11-1.27). No evidence of publication bias was encountered.

Conclusions and relevance: In this systematic review and meta-analysis, female patients with SAB had higher mortality risk than males in both unadjusted and adjusted analyses. Further research is needed to study the potential underlying mechanisms.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Westgeest reported receiving travel fees from IDWeek International Investigator Travel Award during the conduct of the study. Dr Lambregts reported receiving grants from Janssen Pharmaceuticals outside the submitted work. Dr Fowler reported receiving grants from MedImmune, Allergan, Pfizer, Advanced Liquid Logics, Theravance, Novartis, Merck, Medical Biosurfaces, Locus, Affinergy, Contrafect, Karius, Genentech, Regeneron, Basilea, Janssen, Astra Zeneca, and EDE paid to his institution; he reported receiving consulting fees from Novartis, Debiopharm, Genentech, Achaogen, Affinium, Medicines Co, MedImmune, Bayer, Basilea, Affinergy, Janssen, Contrafect, Regeneron, Destiny, Amphliphi Biosciences, Integrated Biotherapeutics, GSK, Armata, Valanbio, Akagera, Aridis, Roche, and Pfizer; he reported holding stock options from Valanbio and ArcBio and honoraria from Infectious Diseases Society of America for service as associate editor outside the submitted work; in addition, Dr Fowler had a patent for sepsis diagnostics pending and a patent for royalties from UpToDate. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Search Flow Diagram of Systematic Review
Figure 2.
Figure 2.. Forest Plot of Unadjusted Mortality in Female vs Male Patients With Staphylococcus aureus Bacteremia
Figure 3.
Figure 3.. Forest Plot of Adjusted Mortality in Female vs Male Patients With Staphylococcus aureus Bacteremia
See this image and copyright information in PMC

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