Sex differences in vancomycin-resistant enterococci bloodstream infections-a systematic review and meta-analysis

Biol Sex Differ. 2021 May 17;12(1):36. doi: 10.1186/s13293-021-00380-5.


Background: Vancomycin-resistant enterococci (VRE) have emerged in the healthcare setting worldwide. Infections with these pathogens, i.e., bloodstream infections (BSI), are accompanied with an impaired patient outcome. Diverse factors comprising patient characteristics, therapeutic strategies, and infection control measures are positively or negatively associated with VRE BSI occurrence. However, whether sex-specific differences influence the frequency of VRE BSI is yet unknown. The aim of this systematic review was to comprehensively summarize and analyze sex prevalence in VRE BSI patients.

Main text: A systematic search for relevant articles was conducted in PubMed and Web of Science. After screening for eligibility, data extraction from included articles and risk of bias assessment were processed. The prevalence of male/female sex in VRE BSI patients and 95% CI were calculated for each study and summarized as pooled estimated effect. In total, nine articles met the inclusion criteria. Risk of bias assessment resulted in low (six studies) to moderate bias (three studies). The pooled prevalence of male patients suffering from VRE BSI was 59% resulting in a 1.4 male/female prevalence ratio.

Conclusions: Current literature suggests sex differences with male preference (59%) in the distribution of VRE BSI cases. Further primary studies should address the question of male-specific factors favoring the enhanced frequency of VRE BSI.

Keywords: Bacteremia; Bloodstream infection; Sex differences; VRE; Vancomycin-resistant enterococci; epidemiology.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Anti-Bacterial Agents
  • Bacteremia* / drug therapy
  • Bacteremia* / epidemiology
  • Female
  • Gram-Positive Bacterial Infections* / drug therapy
  • Gram-Positive Bacterial Infections* / epidemiology
  • Humans
  • Male
  • Sex Characteristics
  • Vancomycin-Resistant Enterococci*


  • Anti-Bacterial Agents