Sex differences in incidence and mortality of bloodstream infections. Results from the population-based HUNT study in Norway

Abstract

ObjectiveTo examine the effect of sex on risk of bloodstream infections (BSI) and BSI mortality and to assess to what extent known risk factors for BSI mediate this association in the general population.ParticipantsThe prospective, population-based HUNT2 Survey (1995-97) in Norway invited 93,898 inhabitants ≥20 years in the Nord-Trøndelag region, whereof 65,237 (69.5%) participated. 46.8% of the participants were men.ExposuresSex and potential mediators between sex and BSI; health behaviours (smoking, alcohol consumption), education attainment, cardiovascular risk factors (systolic blood pressure, non-HDL cholesterol, body mass index) and previous or current comorbidities.Main outcome measuresSex differences in risk of first-time BSI, BSI mortality (death within first 30 days after a BSI), BSI caused by the most frequent bacteria, and the impact of known BSI risk factors as mediators.ResultsWe documented a first-time BSI for 1,840 (2.9%) participants (51.3% men) during a median follow-up of 14.8 years. Of these, 396 (0.6%) died (56.6% men). Men had 41% higher risk of any first-time BSI (95% confidence interval (CI), 28 to 54%) than women. An estimated 34% of the excess risk of BSI in men was mediated by known BSI risk factors. The hazard ratio (HR) with 95% CI for BSI due to S. aureus was 2.09 (1.28 to 2.54), S. pneumoniae 1.36 (1.05 to 1.76), and E. coli 0.97 (0.84 to 1.13) in men vs women. BSI related mortality was higher in men compared to women with HR 1.87 (1.53 to 2.28).ConclusionsThis large population-based study show that men have higher risk of BSI than women. One-third of this effect was mediated by known risk factors for BSI. This raises important questions regarding sex specific approaches to reduce the burden of BSI.

Analysis of SGLT2 Inhibitor Therapy and Other Potential Risk Factors for the Development of Bacteremia in Patients With Urosepsis

“…13 Another possible explanation includes differences in immune responses based on genetic and hormonal factors. 14 Cirrhosis was also associated with an increased risk of bacteremia in our study. Prior studies have consistently identified cirrhosis as a risk factor for bacteremia, with incidence 10 times higher in cirrhotic versus non-cirrhotic patients.…”

“…13 Another possible explanation includes differences in immune responses based on genetic and hormonal factors. 14…”

“…UTIs are more common in females than males; however, male gender has been previously described in the literature as a risk factor for bloodstream infections, including urinary source bloodstream infections. [13][14][15][16][17][18] One possible explanation for this finding could be that UTIs remain undiagnosed and untreated in men for longer, potentially leading to the development of urinary-source bloodstream infections. 13 Another possible explanation includes differences in immune responses based on genetic and hormonal factors.…”

Insomnia symptoms and risk of bloodstream infections: prospective data from the prospective population-based HUNT Study, Norway

“…Whether insomnia is associated with the risk of other and more severe invasive infections, such as bloodstream infections (BSIs) is not clear. BSI is a serious infectious disease, rating among top seven causes of deaths in Europe and North America (Goto & Al-Hasan, 2013), men are more at risk (Randi Marie Mohus et al, 2021), and BSI often leads to sepsis (Laupland et al, 2005). Sepsis is defined as a dysregulated host response to infection, estimated to annually afflict 48.9 million people and cause 11 million deaths worldwide (Rudd et al, 2020).…”