Gender differences in rates of carriage and bloodstream infection caused by methicillin-resistant Staphylococcus aureus: are they real, do they matter and why?

There is increasing interest in sexual and gender dimorphism in disease. We reviewed the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) carriage and bloodstream infection (BSI), which shows a male predominance, and explored some of the possible reasons. Males are more prone to bacterial sepsis, but some studies suggest females may have a poorer prognosis from BSI. Hand-hygiene behavior varies according to gender. Males are less compliant, which in turn may predispose them to higher colonization and infection rates. Female hormones such as estrogen affect the expression of virulence factors in Pseudomonas aeruginosa, and although not studied, this may also apply to S. aureus. Further research is required on the relationship between gender and risk of infection, the reasons for higher MRSA carriage and BSI rates in males, the value of gender-specific infection prevention campaigns, and other factors such as the possible role of contact sports and occupation.