1463. Comparative Evaluation of Adverse Tendon Events Between Recipients of Fluoroquinolones and Ceftriaxone/Azithromycin Among Veterans Affairs Patients with Community Acquired Bacterial Pneumonia

BACKGROUND: Fluoroquinolones (FQs) are used commonly for patients with community acquired bacterial pneumonia (CABP). A recent FDA Drug Safety Communication strengthened labeling regarding tendinopathy/tendon rupture for FQs. The data prompting this change lacked a comparator group of patients using other antibiotics, like ceftriaxone/azithromycin (CTX-AZ) for similar indications. The objectives of this study were to compare the incidence of adverse tendon events (TE) between FQ and CTX-AZ among patients with CABP and determine if FQ treatment is independently associated with TE. METHODS: A retrospective cohort study was performed among patients in the Upstate New York Veterans’ Healthcare Administration. Inclusion criteria: (1) age ≥ 18 years, (2) diagnosis of CABP (ICD9 code with manual confirmation) from January 2014 to December 2015, (3) receipt of IV/oral FQ or CTX-AZ ≥ 1 day, and (4) treatment initiated as inpatient. Data were collected from pt’s medical records. Occurrence of TE was defined using a natural word search algorithm of patients’ clinical progress notes within 90 days of starting FQ or CTX-AZ therapy. Search terms were: tendinopathy, tendon pain, tendon rupture, tendinitis, and Achilles heel pain/tear/torn/rupture. Classification and regression tree (CART) was used to identify breakpoints in continuous variables associated with TE. RESULTS: There were 379 FQ and 274 CTX-AZ recipients. Mean ± standard deviation (SD) ages for FQ and CTX-AZ recipients were, 73.0 ± 12.7 vs. 72.8 ± 12.7 years, respectively. Mean (SD) APACHE-II was significantly higher for FQ than CTX-AZ recipients, 10.2 ± 5.1 vs. 8.5 ± 3.6, respectively (P < 0.001). Residence in the intensive care unit at start of therapy did not differ (FQ: 11.6% vs. CTX-AZ: 10.2%, P = 0.58). The incidence of TE did not differ between groups (FQ: 9/379 [2.4%] vs. CTX-AZ: 4/274 [1.5%], P = 0.57). In multivariate analyses (figure), treatment was not independently associated with TE (aOR: 1.78, 95% confidence interval: 0.51–6.21, P = 0.37) after adjustment for treatment duration, APACHE-II, age ≥52 years and BMI ≥27.5. [Image: see text] CONCLUSION: Incidence of TE did not significantly differ between FQ and CTX-AZ recipients. After adjustment, FQ treatment was not independently associated with an increased risk of TE. DISCLOSURES: T. P. Lodise, paratek: Consultant and Scientific Advisor, Consulting fee.