While it is established that management strategies and outcomes differ
by gender for many diseases, its effect on infection has not been adequately
To investigate the role of gender among hospitalized patients treated
Observational cohort study conducted during a 26-month period from December
1996 through January 1999.
A total of 892 patients in the surgical units of the hospital with 1470
consecutive infectious episodes (782 in men and 688 in women).
Main Outcome Measures
Mortality during hospitalization by gender for infection episodes overall
and for specific infectious sites, including lung, peritoneum, bloodstream,
catheter, urine, surgical site, and skin/soft tissue.
Among all infections, there was no significant difference in mortality
based on gender (men, 11.1% vs women, 14.2%; P =
.07). After logistic regression analysis, factors independently associated
with mortality included higher APACHE (Acute Physiology and Chronic Health
Evaluation) II score, older age, malignancy, blood transfusion, and diagnosis
of infection more than 7 days after admission, but not gender (female odds
ratio [OR] for death, 1.32; 95% confidence interval [CI], 0.90-1.94; P = .16). Mortality was higher in women for lung (men,
18% vs women, 34%; P = .002) and soft tissue (men,
2% vs women, 10%; P≤.05) infection; for other
infectious sites, mortality did not differ by gender. Factors associated with
mortality due to pneumonia by logistic regression included higher APACHE II
score, malignancy, diabetes mellitus, diagnosis of infection more than 7 days
after admission, older age, transplantation, and female gender (OR for death,
2.25; 95% CI, 1.17-4.32; P = .02).
Although gender may not be predictive of mortality among all infections,
women appear to be at increased risk for death from hospital-acquired pneumonia,
even after controlling for other comorbidities.