ArticleEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2026
Sex-related differences in clinical characteristics, management, and outcomes of Enterococcus faecalis bloodstream infection.
Article in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo evaluate whether clinical characteristics and outcomes of patients with Enterococcus faecalis bloodstream infection (EF-BSI) differ by biological sex.
methodsQuasi-experimental study conducted at two hospitals, comprising a retrospective phase (2017-2019) and a prospective intervention phase (2022-2024), including adults with a first episode of monomicrobial EF-BSI. Patients who died within 72 h or were receiving palliative care were excluded. A structured management bundle was implemented in the intervention phase. Clinical features, bundle adherence, and 90-day mortality were compared by sex. Cox regression was used to assess the association between sex and 90-day mortality.
resultsAmong 250 patients, 77 (31%) were females and 173 (69%) males. Females were younger than males (median 63 [50-76] vs. 73 [63-80] years; p < 0.001). Cardiovascular disease was more frequent in males (30 [39%] vs. 94 [54%]; p = 0.025), whereas immunosuppressive therapy (29 [38%] vs. 35 [20%]; p = 0.004) and connective tissue disease (9 [12%] vs. 2 [1%]; p < 0.001) were more frequent in females. Persistent bacteraemia (2/57 [4%] vs. 30/139 [22%]; p = 0.002) and infective endocarditis (14 [18%] vs. 59 [34%]; p = 0.011) were more frequent in males. Females received fewer bundle measures (5 [3-6] vs. 5 [4-6]; p = 0.028), largely because echocardiography and colonoscopy were less frequently indicated. Ninety-day mortality was 22% (17) in females and 14% (25) in males (p = 0.136). Female sex was associated with higher 90-day mortality after adjustment (aHR 2.00, 95%CI 1.04-3.83).
conclusionsFurther studies should explore the underlying causes of these differences and potential implications for individualized management.
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