HAIs and Men's Health: The Most Common Infections

June is Men's Health Month, so we will dedicate this blog post to investigating the risk of acquiring a healthcare-associated infection for male patients. For patients and their caregivers, knowledge is power, and to that end, we hope that this article points out some risks and strategies that may help work towards more positive outcomes.  We will discuss trends observed in male patients in clinical research as reported in medical literature, but we recognizing that anatomy, hormones, and gender identity do not always align in the same way for every individual. 

Males and HAI Risk

While overall, HAIs affect both genders equally, there are some HAIs that are particularly prevalent in male patients at the population level due to anatomical differences, the types of procedures men more frequently undergo, and the higher rate of ventilator use among male patients. Here is a brief overview:

 Surgical Site Infections (SSIs): The risk of SSI goes up with certain procedures, specifically urological and colorectal surgeries.  Because these procedures are more commonly performed in patients with male physiology , the associated SSI risk is also higher in this population. 

 Ventilator-Associated Pneumonia (VAP) & CLABSIs:  Male patients are more frequently admitted to Intensive Care Units (ICUs). Postoperative cardiovascular surgery and trauma account for a massive portion of the sex imbalance in ICU admissions. Due to these conditions, more male patients require prolonged mechanical ventilation or central lines, significantly increasing the risk of these infections due to these indwelling devices.

Are there other reasons for the gender differences in infection?

While the frequency of hospital admission and need for procedures does impact infection risk, there are certain anatomical and biological factors at work, too. Testosterone, the male sex hormone, has been shown to slightly suppress certain immune responses (while estrogen, the female sex hormone, can boost immune response) resulting in more inflammation and stronger symptoms of infection and illnesses of longer duration. The higher levels of cytokines, which produce inflammation, can lead to greater fatigue and body aches. Also related to the immune response, males produce fewer targeted virus-fighting T-cells, which can lead to more severe cases of viral infections.

Additionally, the X chromosome, of which women have two and men have one, contains the highest concentration of immune system genes in the human genome. If any of them are weaker or compromised in the X chromosome in a male patient, he does not have another X chromosome as back-up. Furthermore, males do not benefit from the "mosaic" immune system drawing from two different X chromosomes, which can provide a more diverse and broad range of defenses against infections.

What can male patients do to prevent HAIs?

There are steps that all patients and their caregivers can take to reduce the risk of HAIs. Everyone should follow the instructions from their medical team including how to prepare for a surgery, how to care for a wound, and how to keep indwelling devices safe. Male patients, however, can benefit from having additional information about how their bodies may respond to infection, including their immune system responses.

The most important thing male patients can do is report symptoms of infection as requested by their medical team. Some studies show that men are less likely to report subtle symptoms that may indicate an infection such as aches, increased pain, warmth at an incision site, or other changes. Because early response can have a significant impact on outcomes, it is imperative that male patients report changes to their team or a caregiver so that the proper course of antibiotics can be started.

This month, let's make sure to spread the world about HAI prevention with an added sensitivity to the male patient experience!