Males are at higher risk of colonization and infection with multi-drug-resistant organisms than females.

Background: The global rise in multi-drug-resistant organisms (MDROs) is alarming, and antimicrobial resistance poses a significant public health threat globally. Although certain risk factors are known, including recent antimicrobial therapy, inappropriate use and hospitalization, the focus on gender-specific aspects in MDROs is scarce. The aim of this study was to show gender-specific differences in colonization and infection of multiple MDROs and their detection sites.

Methods: For this multi-centre, retrospective cohort study, surveillance data were collected between 2015 and 2020 from 86 hospitals from Helios Kliniken, Germany. The following multi-drug-resistant bacteria were analysed by sample site: meticillin-resistant Staphylococcus aureus (MRSA); Enterococcus spp.; Escherichia coli; Klebsiella pneumoniae; Pseudomonas aeruginosa; and Acinetobacter baumannii.

Results: Of the 7,081,708 cases in the database, 187,656 patients were found to be colonized with MDROs (2.65%). A documented infection with an MDRO was identified in 33,023 patients (0.466%), with the origin of infection known in 24,231 cases. Male gender was a risk factor for both infection and colonization with any MDRO (P<0.001). Males exhibited a higher likelihood of MDRO detection in superficial skin/soft tissue, blood cultures (P<0.001) and respiratory samples (P=0.002). Additionally, gender-specific differences in MDRO detection site and pathogens were found, with a slightly higher proportion of MRSA infections in deep skin/soft tissue and respiratory samples for females.

Conclusions: This study reinforces the existing hypothesis that male gender is a risk factor for colonization and infection with MDROs, supported by a large dataset. This highlights the need to acknowledge gender-specific MDRO susceptibility in clinical practice.