193 Female sex and mortality in SAB 9 Introduction Staphylococcus aureus, a major cause of bloodstream infections, is associated with high morbidity and mortality [1,2]. Previous studies have reported conflicting results regarding sex-related differences in S. aureus bacteraemia (SAB). Some [3-7], but not all [8-10], previous studies have reported higher mortality rates in women with SAB compared with men. Sex-related differences in outcome may be because of a variety of social or biological factors. For example, in a superantigen-mediated model of toxic shock using human leukocyte antigen (HLA) class II transgenic mice, women were more susceptible to lethal toxic shock caused by S. aureus enterotoxin B [11]. Alternately, previous cohort studies may simply have been limited by small sample size and study design. As a result, the true interaction between sex and outcome among patients with SAB is unknown. The primary aim of this study was to determine the independent association of female sex with mortality in patients with SAB. Next, we sought to identify differences in patient, disease and management characteristics between women and men. The large study size and detailed prospective data collection, including bacterial genotyping provided the unique possibility to address the ongoing controversy on sex differences in SAB. Methods Study population This is a post hoc analysis of prospectively collected data from the S. aureus Bacteraemia Group Prospective Cohort Study (SABG- PCS). Adult (2:18 years), hospitalized, nonneutropenic (neutrophil count >1 x 109/L) patients with monomicrobial SAB at Duke University Medical Center were enrolled from 1994 to 2020. Beginning in 2001, written informed consent was obtained from patients or their legal representatives to comply with Health Insurance Portability and Accountability Act regulations. If a patient died before the notification of their blood culture results, the patient was included using an institutional review boardeapproved Notification of Decedent Research. From March until September 2020, because of the COVID-19 pandemic, enrolment was temporarily paused. If a patient experienced multiple SAB episodes, only the initial episode was included. Follow-up was done through participants’ medical records assessment at 90 days after first positive blood culture for all patients. Both clinical and microbiological data are collected in the SABG-PCS. Enrolment and data collection methods have been published previously [2].
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