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

Author:

Chen Yin‐Yang12,Yang Shun‐Fa13ORCID,Yeh Han‐Wei45ORCID,Yeh Ying‐Tung67ORCID,Huang Jing‐Yang14ORCID,Tsao Shao‐Lun89,Yeh Chao‐Bin11011ORCID

Affiliation:

1. Institute of MedicineChung Shan Medical University Taichung Taiwan

2. Department of Surgery Chung Shan Medical University Hospital Taichung Taiwan

3. Department of Medical Research Chung Shan Medical University Hospital Taichung Taiwan

4. School of Medicine Chang Gung University Taoyuan City Taiwan

5. Medical Education Department Chang Gung Memorial Hospital, Linkou Taoyuan City Taiwan

6. Graduate School of Dentistry School of Dentistry Chung Shan Medical University Taichung Taiwan

7. Department of Dentistry Chung Shan Medical University Hospital Taichung Taiwan

8. Department of Biomedical Engineering Chung Yuan Christian University Taoyuan Taiwan

9. Department of Anesthesiology Changhua Christian Hospital Changhua Taiwan

10. Department of Emergency Medicine School of Medicine Chung Shan Medical University Taichung Taiwan

11. Department of Emergency Medicine Chung Shan Medical University Hospital Taichung Taiwan

Abstract

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

Reference40 articles.

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3. ACOG Practice Bulletin No. 91: Treatment of Urinary Tract Infections in Nonpregnant Women

4. Association between Source of Infection and Hospital Mortality in Patients Who Have Septic Shock

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