215 Meta-analysis female sex and mortality in SAB 10 Introduction Staphylococcus aureus is the leading cause of death due to bacterial bloodstream infection [1]. Previously identified risk factors for mortality in patients with Staphylococcus aureus bacteremia (SAB) have included increasing age, infective endocarditis, hemodialysis dependence, and persistent bacteremia, among others [2]. Female sex has been suggested as risk factor for mortality in SAB in several studies, with an increase of mortality of up to 30% relative to male patients [3-5]. However, other studies found no sex inequality in outcome of SAB [6,7], or even a higher mortality in male individuals in a subgroup of patients with a higher comorbidity score [8]. Thus, the impact of female sex in SAB remains unclear. The aim of this systematic review and meta-analysis was to determine whether female sex is associated with mortality in SAB. Methods The key question of this systematic review was: is female sex associated with increased mortality risk in patients with SAB? The study protocol was registered on Prospero (CRD42022373176). We followed the meta-analysis of observational studies in epidemiology Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline as the included studies involved observational data. Search strategy We conducted a literature search of MEDLINE via PubMed, Embase via Elsevier, and Web of Science Core Collection (1900 to present) via Clarivate from inception to October 31, 2022, using a combination of key words to capture S aureus, bacteremia, mortality, and sex (eAppendix 1 in Supplement 1). An experienced medical librarian (S.K.) devised, developed, and executed the search with input from the entire team. The search was peer reviewed by a second medical librarian according to a modified Peer Review of Electronic Search Strategies (PRESS) checklist [9]. No limitations were placed on language in the initial search, but studies published in languages other than English were excluded in the full-text review phase. A search update was conducted on April 26, 2023, to identify newly published studies. In addition, we hand-searched key references to identify citations not captured in the electronic database searches. All results were compiled in EndNote and imported into Covidence, a web-based data synthesis software program [10], for deduplication and screening.
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