15 General Introduction 1 Although very rare in countries with low MRSA prevalence such as the Netherlands, persistent MRSA bacteremia is relatively common in the United States [41]. A variety of host and pathogen factors are potentially associated with persistence, and few alternative therapeutical options for persistent bacteremia have gradually evolved over time. We reviewed the literature on persistent MRSA bacteremia in chapter 8. S. aureus bacteremia affects both males and females around the globe. Females have a lower a priori risk of acquiring S. aureus bacteremia compared to males, and represent approximately 40% of the S. aureus bacteremia population [42]. Although less frequently affected, some previous studies reported an increased mortality risk of up to 30% in females with S. aureus bacteremia as compared to males [43, 44]. However, other studies did not find a sex inequality in mortality, or even a higher mortality in males in a subgroup of patients with more comorbidities [45, 46]. Thus, the impact of female sex on outcome among patients with S. aureus bacteremia remained unclear. Chapter 9 describes our study on sex-differences in mortality, patient characteristics, disease aspects and management, in a large cohort of over 3,000 S. aureus bacteremia patients. In chapter 10, a systematic review and metaanalysis was conducted to determine the true association of female sex and mortality in S. aureus bacteremia. The results of this thesis are summarized and discussed in chapter 11.
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