Bugs That Can Resist Antibiotics but Not Men: Gender-Specific Differences in Notified Infections and Colonisations in Germany, 2010-2019.

Michael Brandl,Tim Eckmanns,Annicka Reuss,Felix Reichert,Niklas Willrich,Jan Walter,Sebastian Haller,Alexandra Hoffmann

doi:10.3390/microorganisms9050894

Abstract

Data from surveillance networks show that men have a higher incidence rate of infections with anti-microbial-resistant (AMR) pathogens than women. We systematically analysed data of infections and colonisations with AMR pathogens under mandatory surveillance in Germany to quantify gender-specific differences. We calculated incidence-rates (IR) per 100,000 person–years for invasive infections with Methicillin-resistant Staphylococcus aureus (MRSA), and for infections or colonisations with carbapenem-non-susceptible Acinetobacter spp. (CRA), and Enterobacterales (CRE), using the entire German population as a denominator. We limited the study periods to years with complete notification data (MRSA: 2010–2019, CRA/CRE: 2017–2019). We used Poisson regression to adjust for gender, age group, federal state, and year of notification. In the study periods, IR for all notifications were 4.2 for MRSA, 0.90 for CRA, and 4.8 for CRE per 100,000 person-–years. The adjusted IR ratio for infections of men compared to women was 2.3 (95% confidence interval [CI]: 2.2–2.3) for MRSA, 2.2 (95%CI: 1.9–2.7) for CRA, and 1.7 (95%CI: 1.6–1.8) for CRE. Men in Germany show about double the risk for infection with AMR pathogens than women. This was also true for colonisations, where data were available. Screening procedures and associated hygiene measures may profit from a gender-stratified approach.

Highlights

Anti-microbial resistance (AMR) was identified as one of ten threats to human life by the World Health Organization (WHO) in 2019 [1]
The WHO called for applying the “gender lens” to analysis of surveillance data in order to successfully deal with AMR [5]
For men, across age groups, federal states, and years under investigation, the risk for infections with investigated antibiotic-resistant bacteria was increased by factor 1.7 to 2.3

Summary

Introduction

Anti-microbial resistance (AMR) was identified as one of ten threats to human life by the World Health Organization (WHO) in 2019 [1]. An estimated 33,000 people die each year due to an infection with antibiotic-resistant bacteria in the European Union and European Economic Area [2]. Quantification of the true global burden of AMR would be essential to allocate adequate resources and inform public health action, but proved to be difficult due to a lack of high-quality and population-representative data [3,4]. Data from the European Antimicrobial Resistance Surveillance Network (EARS-Net) show that men have a higher incidence of infections with the majority of the eight bacterial species under surveillance [6].

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