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Association Between Aortic Aneurysm and Aortic Dissection With Fluoroquinolones Use in Patients With Urinary Tract Infections: A Population‐Based Cohort Study

BACKGROUND: Fluoroquinolones are first‐line antibiotics recommended for the treatment of complicated urinary tract infections (UTIs), with frequent reports of adverse effects of aortic aneurysm (AA) and aortic dissection (AD). We examined whether fluoroquinolones can increase the risk of AA and AD i...

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Autores principales: Chen, Yin‐Yang, Yang, Shun‐Fa, Yeh, Han‐Wei, Yeh, Ying‐Tung, Huang, Jing‐Yang, Tsao, Shao‐Lun, Yeh, Chao‐Bin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9075302/
https://www.ncbi.nlm.nih.gov/pubmed/35229623
http://dx.doi.org/10.1161/JAHA.121.023267
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author Chen, Yin‐Yang
Yang, Shun‐Fa
Yeh, Han‐Wei
Yeh, Ying‐Tung
Huang, Jing‐Yang
Tsao, Shao‐Lun
Yeh, Chao‐Bin
author_facet Chen, Yin‐Yang
Yang, Shun‐Fa
Yeh, Han‐Wei
Yeh, Ying‐Tung
Huang, Jing‐Yang
Tsao, Shao‐Lun
Yeh, Chao‐Bin
author_sort Chen, Yin‐Yang
collection PubMed
description BACKGROUND: Fluoroquinolones are first‐line antibiotics recommended for the treatment of complicated urinary tract infections (UTIs), with frequent reports of adverse effects of aortic aneurysm (AA) and aortic dissection (AD). We examined whether fluoroquinolones can increase the risk of AA and AD in patients with UTIs in the Taiwanese population. METHODS AND RESULTS: We used the National Health Insurance Research Database to identify patients diagnosed with UTIs under single antibiotic treatment of fluoroquinolones and first‐, second‐, or third‐generation cephalosporins. An AA and AD diagnosis within a year constituted the study event. Multivariable analysis with a multiple Cox regression model was applied for comparing the hazard risk of AA and AD between fluoroquinolones and first‐ or second‐generation cephalosporins. Propensity score matching was performed to reduce the potential for bias caused by measured confounding variables. Among 1 249 944 selected patients with UTIs, 28 568 patients were assigned to each antibiotic group after propensity score matching. The incidence of AA and AD was not significantly different between the fluoroquinolones and first‐ or second‐generation cephalosporins (adjusted HR [aHR], 0.86 [95% CI, 0.59–1.27]). However, the mortality increased in the fluoroquinolones group (aHR, 1.10 [95% CI, 1.04–1.16]). CONCLUSIONS: Compared with first‐ or second‐generation cephalosporins, fluoroquinolones were not associated with increased risk of AA and AD in patients with UTI. However, a significant risk of mortality was still found in patients treated with fluoroquinolones. The priority is to control infections with adequate antibiotics rather than exclude fluoroquinolones considering the risk of AA and AD for patients with UTI.
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spelling pubmed-90753022022-05-10 Association Between Aortic Aneurysm and Aortic Dissection With Fluoroquinolones Use in Patients With Urinary Tract Infections: A Population‐Based Cohort Study Chen, Yin‐Yang Yang, Shun‐Fa Yeh, Han‐Wei Yeh, Ying‐Tung Huang, Jing‐Yang Tsao, Shao‐Lun Yeh, Chao‐Bin J Am Heart Assoc Original Research BACKGROUND: Fluoroquinolones are first‐line antibiotics recommended for the treatment of complicated urinary tract infections (UTIs), with frequent reports of adverse effects of aortic aneurysm (AA) and aortic dissection (AD). We examined whether fluoroquinolones can increase the risk of AA and AD in patients with UTIs in the Taiwanese population. METHODS AND RESULTS: We used the National Health Insurance Research Database to identify patients diagnosed with UTIs under single antibiotic treatment of fluoroquinolones and first‐, second‐, or third‐generation cephalosporins. An AA and AD diagnosis within a year constituted the study event. Multivariable analysis with a multiple Cox regression model was applied for comparing the hazard risk of AA and AD between fluoroquinolones and first‐ or second‐generation cephalosporins. Propensity score matching was performed to reduce the potential for bias caused by measured confounding variables. Among 1 249 944 selected patients with UTIs, 28 568 patients were assigned to each antibiotic group after propensity score matching. The incidence of AA and AD was not significantly different between the fluoroquinolones and first‐ or second‐generation cephalosporins (adjusted HR [aHR], 0.86 [95% CI, 0.59–1.27]). However, the mortality increased in the fluoroquinolones group (aHR, 1.10 [95% CI, 1.04–1.16]). CONCLUSIONS: Compared with first‐ or second‐generation cephalosporins, fluoroquinolones were not associated with increased risk of AA and AD in patients with UTI. However, a significant risk of mortality was still found in patients treated with fluoroquinolones. The priority is to control infections with adequate antibiotics rather than exclude fluoroquinolones considering the risk of AA and AD for patients with UTI. John Wiley and Sons Inc. 2022-03-01 /pmc/articles/PMC9075302/ /pubmed/35229623 http://dx.doi.org/10.1161/JAHA.121.023267 Text en © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Chen, Yin‐Yang
Yang, Shun‐Fa
Yeh, Han‐Wei
Yeh, Ying‐Tung
Huang, Jing‐Yang
Tsao, Shao‐Lun
Yeh, Chao‐Bin
Association Between Aortic Aneurysm and Aortic Dissection With Fluoroquinolones Use in Patients With Urinary Tract Infections: A Population‐Based Cohort Study
title Association Between Aortic Aneurysm and Aortic Dissection With Fluoroquinolones Use in Patients With Urinary Tract Infections: A Population‐Based Cohort Study
title_full Association Between Aortic Aneurysm and Aortic Dissection With Fluoroquinolones Use in Patients With Urinary Tract Infections: A Population‐Based Cohort Study
title_fullStr Association Between Aortic Aneurysm and Aortic Dissection With Fluoroquinolones Use in Patients With Urinary Tract Infections: A Population‐Based Cohort Study
title_full_unstemmed Association Between Aortic Aneurysm and Aortic Dissection With Fluoroquinolones Use in Patients With Urinary Tract Infections: A Population‐Based Cohort Study
title_short Association Between Aortic Aneurysm and Aortic Dissection With Fluoroquinolones Use in Patients With Urinary Tract Infections: A Population‐Based Cohort Study
title_sort association between aortic aneurysm and aortic dissection with fluoroquinolones use in patients with urinary tract infections: a population‐based cohort study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9075302/
https://www.ncbi.nlm.nih.gov/pubmed/35229623
http://dx.doi.org/10.1161/JAHA.121.023267
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