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Gender affects prognosis of methicillin-resistant Staphylococcus aureus bacteremia differently depending on the severity of underlying disease

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Abstract

We aimed to elucidate the potential impact of gender on prognosis of Staphylococcus aureus bacteremia (SAB). We analyzed SAB cases prospectively collected over an 8-year period at 11 hospitals in Korea. SAB-related mortality was pre-defined as a death within 30 days from the onset of SAB without other apparent cause of death. The effect of gender on SAB-related mortality was examined in the entire cohort and in subgroups stratified according to methicillin resistance and Charlson’s comorbidity-weighted index (CCWI) score. Those factors independently associated to SAB-related mortality were explored. Among 1974 eligible cases, SAB-related mortality rates in male and female were 21.2% (259/1224) and 21.9% (164/750), respectively (P = 0.786). The SAB-related mortality rate was independently higher in male than that in female in CCWI score ≤ 3 methicillin-resistant SAB (MRSAB) group (15.9 vs. 6.2%; aOR 3.65, 95% CI 1.46–9.13; P = 0.006) while the association tended to be inverse when CCWI score rises. Interaction between CCWI score and gender to MRSAB-related mortality was significant in multivariate analysis (aOR 0.85, 95% CI 0.74–0.96; P = 0.011). There was no significant interaction between gender and CCWI in entire SAB or methicillin-susceptible SAB cohorts. Gender may affect clinical outcomes of MRSAB differently depending on the severity of underlying disease.

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References

  1. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, Kaplan SL, Karchmer AW, Levine DP, Murray BE, M JR, Talan DA, Chambers HF (2011) Clinical practice guidelines by the Infectious Diseases Society Of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis 52(3):285–292

    Article  PubMed  Google Scholar 

  2. van Hal SJ, Jensen SO, Vaska VL, Espedido BA, Paterson DL, Gosbell IB (2012) Predictors of mortality in Staphylococcus aureus bacteremia. Clin Microbiol Rev 25(2):362–386

    Article  PubMed  PubMed Central  Google Scholar 

  3. Smit J, Lopez-Cortes LE, Kaasch AJ, Sogaard M, Thomsen RW, Schonheyder HC, Rodriguez-Bano J, Nielsen H (2017) Gender differences in the outcome of community-acquired Staphylococcus aureus bacteraemia: a historical population-based cohort study. Clin Microbiol Infect 23(1):27–32

    Article  CAS  PubMed  Google Scholar 

  4. Humphreys H, Fitzpatick F, Harvey BJ (2015) 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 61(11):1708–1714

    CAS  PubMed  Google Scholar 

  5. Mansur N, Hazzan R, Paul M, Bishara J, Leibovici L (2012) Does sex affect 30-day mortality in Staphylococcus aureus bacteremia? Gend Med 9(6):463–470

    Article  PubMed  Google Scholar 

  6. Song KH, Kim ES, Sin HY, Park KH, Jung SI, Yoon N, Kim DM, Lee CS, Jang HC, Park Y, Lee KS, Kwak YG, Lee JH, Park SY, Song M, Park SK, Lee YS, Kim HB, Korea IDsg (2013) Characteristics of invasive Staphylococcus aureus infections in three regions of Korea, 2009-2011: a multi-center cohort study. BMC Infect Dis 13:581

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kim ES, Kim HB, Kim G, Kim KH, Park KH, Lee S, Choi YH, Yi J, Kim CJ, Song KH, Choe PG, Kim NJ, Lee YS, Oh MD, Korea IDsg (2014) Clinical and epidemiological factors associated with methicillin resistance in community-onset invasive Staphylococcus aureus infections: prospective multicenter cross-sectional study in Korea. PLoS One 9(12):e114127

    Article  PubMed  PubMed Central  Google Scholar 

  8. Song KH, Jung SI, Lee S, Park S, Kiem SM, Lee SH, Kwak YG, Kim YK, Jang HC, Kim YS, Kim HI, Kim CJ, Park KH, Kim NJ, Oh MD, Kim HB, Korea IDsg (2017) Characteristics of cefazolin inoculum effect-positive methicillin-susceptible Staphylococcus aureus infection in a multicentre bacteraemia cohort. Eur J Clin Microbiol Infect Dis 36(2):285–294

    Article  CAS  PubMed  Google Scholar 

  9. Lee S, Song KH, Jung SI, Park WB, Lee SH, Kim YS, Kwak YG, Kim YK, Kiem SM, Kim HI, Kim ES, Park KH, Kim NJ, Jang HC, Kim HB, Korea IDsg (2017) Comparative outcomes of cefazolin versus nafcillin for methicillin-susceptible Staphylococcus aureus bacteraemia: a prospective multicentre cohort study in Korea. Clin Microbiol Infect 24(2):152–158

  10. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    Article  CAS  PubMed  Google Scholar 

  11. Paterson DL, Ko WC, Von Gottberg A, Mohapatra S, Casellas JM, Goossens H, Mulazimoglu L, Trenholme G, Klugman KP, Bonomo RA, Rice LB, Wagener MM, McCormack JG, Yu VL (2004) International prospective study of Klebsiella pneumoniae bacteremia: implications of extended-spectrum beta-lactamase production in nosocomial infections. Ann Intern Med 140(1):26–32

    Article  PubMed  Google Scholar 

  12. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the working group on Sepsis-related problems of the European Society of Intensive Care Medicine. Intensive Care Med 22(7):707–710

    Article  CAS  PubMed  Google Scholar 

  13. Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, Lamm W, Clark C, MacFarquhar J, Walton AL, Reller LB, Sexton DJ (2002) Health care–associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 137(10):791–797

    Article  PubMed  Google Scholar 

  14. Kang CK, Kim YK, Jung SI, Park WB, Song KH, Park KH, Choe PG, Jang HC, Lee S, Kim YS, Kwak YG, Kwon KT, Kiem S, Kim CJ, Kim ES, Kim HB, Korea IDsg (2017) agr functionality affects clinical outcomes in patients with persistent methicillin-resistant Staphylococcus aureus bacteraemia. Eur J Clin Microbiol Infect Dis 36(11):2187–2191

    Article  CAS  PubMed  Google Scholar 

  15. Jang HC, Kim SH, Kim KH, Kim CJ, Lee S, Song KH, Jeon JH, Park WB, Kim HB, Park SW, Kim NJ, Kim EC, Oh MD, Choe KW (2009) Salvage treatment for persistent methicillin-resistant Staphylococcus aureus bacteremia: efficacy of linezolid with or without carbapenem. Clin Infect Dis 49(3):395–401

    Article  CAS  PubMed  Google Scholar 

  16. Harbarth S, Rutschmann O, Sudre P, Pittet D (1998) Impact of methicillin resistance on the outcome of patients with bacteremia caused by Staphylococcus aureus. Arch Intern Med 158(2):182–189

    Article  CAS  PubMed  Google Scholar 

  17. Schroder J, Kahlke V, Book M, Stuber F (2000) Gender differences in sepsis: genetically determined? Shock 14(3):307–310 discussion 310-303

    Article  CAS  PubMed  Google Scholar 

  18. Angele MK, Pratschke S, Hubbard WJ, Chaudry IH (2014) Gender differences in sepsis: cardiovascular and immunological aspects. Virulence 5(1):12–19

    Article  PubMed  Google Scholar 

  19. van Vught LA, Scicluna BP, Wiewel MA, Hoogendijk AJ, Kleinklouwenberg PMC, Ong DSY, Cremer OL, Horn J, Franitza M, Toliat MR, Nurnberg P, MMJ B, Schultz MJ, van der Poll T, Consortium M (2017) Association of gender with outcome and host response in critically ill sepsis patients. Crit Care Med 45(11):1854–1862

    Article  PubMed  Google Scholar 

  20. Nachtigall I, Tafelski S, Rothbart A, Kaufner L, Schmidt M, Tamarkin A, Kartachov M, Zebedies D, Trefzer T, Wernecke KD, Spies C (2011) Gender-related outcome difference is related to course of sepsis on mixed ICUs: a prospective, observational clinical study. Crit Care 15(3):R151

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The study involved three multicenter SAB cohorts. The cohorts comprised SAB cases occurring from July 2009 to June 2011 (grants 02-2012-035 from the SNUBH Research Fund and 2009-E00609-00 from the Korea Centers for Disease Control and Prevention) [6], from May to December 2012 (grant 2012-E44003-00 from the Korea Centers for Disease Control and Prevention) [7], and from September 2013 to March 2015 (grant HI10C2020 from the National Strategic Coordinating Centre for Clinical Research, for the cohort study “Korea Infectious Diseases Study Group/Staphylococcus aureus Bacteremia 2013[KIND-SAB 2013]”) [8, 9].

We thank the members of the Korea INfectious Diseases (KIND) study group and associated staff for their cooperation in this study. In addition to the authors, the following were participants in the study group: Taek Soo Kim, Kyoung Un Park, Jeong Eun Cho, Yun Jung Choi, Jung In Park (Seoul National University Bundang Hospital); Chong Rae Cho, Hyun Suk Song, Young Soon Lee (Inje University Ilsan Paik Hospital); Su-Mi Choi (Chonnam National University Hospital); Myoung-don Oh, Pyoeng Gyun Choe, Su Jin Choi (Seoul National University Hospital); Hee Kyoung Choi, Myung Sook Han (Yonsei University Wonju Severance Christian Hospital); Seung-Ji Kang, Hyeon-jeong Hwang (Chonnam National University Hwasun Hospital); Shinhye Cheon, Jin Hee Hwang, Seon Jin Yun (Chungnam National University Hospital); Jongyoun Yi, Sohee Park (Pusan National University Hospital); Sungmin Kiem, Dong-Kie Kim, Sae-Am Song, Min Ji Kang, and Jae Gyun Shin (Inje University Haeundae Paik Hospital); Hye-In Kim, Seung Min Shin (Daegu Fatima Hospital).

Funding

This work was supported by SNUBH Research Fund (Grant No. 02-2017-003) and Support Program for Women in Science, Engineering and Technology through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (Grant No. 2016H1C3A1903202).

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Author notes

  1. Chang Kyung Kang and Yee Gyung Kwak are co-first authors.

Authors and Affiliations

  1. Seoul National University Bundang Hospital, Seongnam, South Korea

    Chang Kyung Kang, Youngmi Park, Kyoung-Ho Song, Eu Suk Kim & Hong Bin Kim

  2. Inje University Ilsan Paik Hospital, Goyang, South Korea

    Yee Gyung Kwak

  3. Chonnam National University Hospital, Gwangju, South Korea

    Sook-In Jung & Kyung-Hwa Park

  4. Seoul National University Hospital, Seoul, South Korea

    Wan Beom Park & Nam Joong Kim

  5. Yonsei University Wonju College of Medicine, Wonju, South Korea

    Young Keun Kim

  6. Chonnam National University Hwasun Hospital, Hwasun, South Korea

    Hee-Chang Jang

  7. Pusan National University Hospital, Busan, South Korea

    Shinwon Lee

  8. Inje University Haeundae Paik Hospital, Busan, South Korea

    Jae Hyun Jeon

  9. Daegu Fatima Hospital, Daegu, South Korea

    Ki Tae Kwon

  10. Ehwa Womans University Hospital, Seoul, South Korea

    Chung-Jong Kim

  11. Chungnam National University School of Medicine, Daejeon, Republic of Korea

    Yeon-Sook Kim

Authors
  1. Chang Kyung Kang
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  2. Yee Gyung Kwak
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  3. Youngmi Park
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  11. Hee-Chang Jang
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  12. Shinwon Lee
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  15. Chung-Jong Kim
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  16. Yeon-Sook Kim
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  17. Hong Bin Kim
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the Korea INfectious Diseases (KIND) study group

Corresponding authors

Correspondence to Yeon-Sook Kim or Hong Bin Kim.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

Formal consent was not required in this study. The analyses of cases from April 2015 to February 2017 were also approved by the institutional review board of Seoul National University Bundang Hospital (IRB No. B-1708-417-106).

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Kang, C.K., Kwak, Y.G., Park, Y. et al. Gender affects prognosis of methicillin-resistant Staphylococcus aureus bacteremia differently depending on the severity of underlying disease. Eur J Clin Microbiol Infect Dis 37, 1119–1123 (2018). https://doi.org/10.1007/s10096-018-3226-6

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  • DOI: https://doi.org/10.1007/s10096-018-3226-6

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