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 in...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.023267 |
| _version_ | 1797859055275868160 |
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| author | Yin‐Yang Chen Shun‐Fa Yang Han‐Wei Yeh Ying‐Tung Yeh Jing‐Yang Huang Shao‐Lun Tsao Chao‐Bin Yeh |
| author_facet | Yin‐Yang Chen Shun‐Fa Yang Han‐Wei Yeh Ying‐Tung Yeh Jing‐Yang Huang Shao‐Lun Tsao Chao‐Bin Yeh |
| author_sort | Yin‐Yang Chen |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-04-09T21:23:18Z |
| format | Article |
| id | doaj.art-f51a56c7a9e54bba92aac8c532c28b67 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-09T21:23:18Z |
| publishDate | 2022-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-f51a56c7a9e54bba92aac8c532c28b672023-03-28T04:20:50ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-03-0111610.1161/JAHA.121.023267Association Between Aortic Aneurysm and Aortic Dissection With Fluoroquinolones Use in Patients With Urinary Tract Infections: A Population‐Based Cohort StudyYin‐Yang Chen0Shun‐Fa Yang1Han‐Wei Yeh2Ying‐Tung Yeh3Jing‐Yang Huang4Shao‐Lun Tsao5Chao‐Bin Yeh6Institute of MedicineChung Shan Medical University Taichung TaiwanInstitute of MedicineChung Shan Medical University Taichung TaiwanSchool of Medicine Chang Gung University Taoyuan City TaiwanGraduate School of Dentistry School of Dentistry Chung Shan Medical University Taichung TaiwanInstitute of MedicineChung Shan Medical University Taichung TaiwanDepartment of Biomedical Engineering Chung Yuan Christian University Taoyuan TaiwanInstitute of MedicineChung Shan Medical University Taichung TaiwanBackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.121.023267aortic aneurysmaortic dissectionfluoroquinolonesurinary tract infections |
| spellingShingle | Yin‐Yang Chen Shun‐Fa Yang Han‐Wei Yeh Ying‐Tung Yeh Jing‐Yang Huang Shao‐Lun Tsao Chao‐Bin Yeh Association Between Aortic Aneurysm and Aortic Dissection With Fluoroquinolones Use in Patients With Urinary Tract Infections: A Population‐Based Cohort Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic aneurysm aortic dissection fluoroquinolones urinary tract infections |
| 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 | aortic aneurysm aortic dissection fluoroquinolones urinary tract infections |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.023267 |
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