Fluoroquinolones Are Associated With Increased Risk of Aortic Aneurysm or Dissection: Systematic Review and Meta-analysis

Ribeiro, Nuno Vouga; Melo, Ryan Gouveia e; Guerra, Nuno; Nobre, Ângelo; Fernandes, Ricardo M; Pedro, Luís Mendes; Costa, João; Pinto, Fausto J.; Caldeira, Daniel

doi:10.1053/j.semtcvs.2020.11.011

Cited by 14 publications

(12 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies have presented conflicting findings on the presence and causality of an association between fluoroquinolones and aortic aneurysm or dissection . Most studies identifying an association used nonuse, amoxicillin, or azithromycin as comparators.…”

Section: Discussionmentioning

confidence: 99%

“…Given that aortic diseases similarly involve collagen degradation, a 2015 cohort study investigated the association, finding increased hospitalization with aortic aneurysm or dissection following fluoroquinolone prescription. Subsequent studies have produced conflicting findings and differing conclusions on the causality of the association . It is estimated that abdominal aortic aneurysms are responsible for 1.3% of deaths in men aged 65 to 85 years in high-income countries .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association Between Fluoroquinolone Use and Hospitalization With Aortic Aneurysm or Aortic Dissection

et al. 2023

View full text Add to dashboard Cite

ImportanceFluoroquinolone use has been associated with increased hospitalization with aortic aneurysm or dissection in noninterventional studies, but the reason for this observed association is unclear.ObjectiveTo determine the association between fluoroquinolone use and aortic aneurysm or dissection using multiple study designs and multiple databases to increase the robustness of findings.Design, Setting, and ParticipantsCohort and case-crossover studies were conducted separately in 2 databases of UK primary care records. Clinical Practice Research Datalink Aurum and GOLD primary care records were linked to hospital admissions data. Adults with a systemic fluoroquinolone or cephalosporin prescription between April 1997 and December 2019 were included in the cohort study. Adults hospitalized with aortic aneurysm or dissection within the eligibility period were included in the case-crossover study. Individuals meeting inclusion criteria in the case-crossover study were matched 1:3 to control individuals on age, sex, index date, and clinical practice to adjust for calendar trends in prescribing. Data were analyzed from January to July 2022.ExposuresSystemic fluoroquinolone or comparator antibiotic.Main Outcomes and MeasuresHazard ratios (HRs) were estimated in the cohort study for the association between prescription of fluoroquinolones and hospitalization with aortic aneurysm or dissection using stabilized inverse probability of treatment-weighted Cox regression. Odds ratios (OR) were estimated in the case-crossover study for the association between systemic fluoroquinolone use and hospitalization with aortic aneurysm or dissection using a conditional logistic regression model. Estimates were pooled across databases using fixed-effects meta-analysis.ResultsIn the cohort study, we identified 3 134 121 adults in Aurum (mean [SD] age, 52.5 [20.3] years; 1 969 257 [62.8%] female) and 452 086 in GOLD (mean [SD] age, 53.9 [20.2] years; 286 502 [63.4%] female) who were prescribed fluoroquinolones or cephalosporins. In crude analyses, fluoroquinolone relative to cephalosporin use was associated with increased hospitalization with aortic aneurysm or dissection (pooled HR, 1.28; 95% CI, 1.13-1.44; P &lt; .001) but after adjustment for potential confounders, this association disappeared (pooled adjusted HR, 1.03; 95% CI, 0.91-1.17; P = .65). In the case-crossover study, we identified 84 841 individuals hospitalized with aortic aneurysm or dissection in Aurum (mean [SD] age, 75.5 [10.9]; 23 551 [27.8%] female) and 10 357 in GOLD (mean [SD] age, 75.6 [10.5]; 2809 [27.1%] female). Relative to nonuse, fluoroquinolone use was associated with an increase in hospitalization with aortic aneurysm or dissection, but no association was found relative to other antibiotics (vs cephalosporin pooled OR, 1.05; 95% CI, 0.87-1.27; vs trimethoprim, 0.89; 95% CI, 0.75-1.06; vs co-amoxiclav, 0.98; 95% CI, 0.82-1.18).Conclusions and RelevanceThe results in this study suggest that estimates of association of fluoroquinolones with aortic aneurysm or dissection may be affected by confounding. When such confounding is accounted for, no association was evident, providing reassurance on the safety of fluoroquinolones with respect to aortic aneurysm or dissection.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association Between Fluoroquinolone Use and Hospitalization With Aortic Aneurysm or Aortic Dissection

et al. 2023

View full text Add to dashboard Cite

show abstract

“…An association of macrolide with levofloxacin offers activity against S. aureus, but there is little data about its efficacy and some studies have even shown a worse prognosis [28]. In addition, the use of fluoroquinolones is associated with severe adverse effects [32,33]. The potent activity of ceftaroline against S. aureus, the possibility to combine it with a macrolide, and the present article showing good outcomes in patients with severe CAP highlight how such a combination could offer broad-spectrum coverage, potent bactericidal activity, and the potential benefits of macrolides.…”

Section: Discussionmentioning

confidence: 99%

Impact on in-hospital mortality of ceftaroline versus standard of care in community-acquired pneumonia: a propensity-matched analysis

Cillóniz

Méndez²,

Peroni

et al. 2021

Eur J Clin Microbiol Infect Dis

View full text Add to dashboard Cite

The purpose of this study is to evaluate the in-hospital mortality of community-acquired pneumonia (CAP) treated with ceftaroline in comparison with standard therapy. This was a retrospective observational study in two centers. Hospitalized patients with CAP were grouped according to the empiric regimen (ceftaroline versus standard therapy) and analyzed using a propensity score matching (PSM) method to reduce confounding factors. Out of the 6981 patients enrolled, 5640 met the inclusion criteria, and 89 of these received ceftaroline. After PSM, 78 patients were considered in the ceftaroline group (cases) and 78 in the standard group (controls). Ceftaroline was mainly prescribed in cases with severe pneumonia (67% vs. 56%, p = 0.215) with high suspicion of Staphylococcus aureus infection (9% vs. 0%, p = 0.026). Cases had a longer length of hospital stay (13 days vs. 10 days, p = 0.007), while an increased risk of in-hospital mortality was observed in the control group compared to the case group (13% vs. 21%, HR 0.41; 95% CI 0.18 to 0.62, p = 0.003). The empiric use of ceftaroline in hospitalized patients with severe CAP was associated with a decreased risk of in-hospital mortality.

show abstract

“…In that study, the authors still found a diminished but still relatively high risk of AA/AD (OR 2.26 for no antibiotic use vs. 1.56 for β-lactam use). 31 A 2021 meta-analysis stated that the risk of AA/AD with fluoroquinolone use was similar to that with other broad-spectrum antibiotics. 32 The authors have affected the results, such as computed tomography, blood pressure, body mass index, tobacco use, congenital collagen disorders, ongoing infection, and family history of aortic disease.…”

Section: Study Limitationsmentioning

confidence: 99%

“…32 The authors have affected the results, such as computed tomography, blood pressure, body mass index, tobacco use, congenital collagen disorders, ongoing infection, and family history of aortic disease. 31 Future studies should attempt to control for as many potential confounders as possible. Second, ICD-9-CM codes were used to identify all diagnoses, which may be subject to misdiagnosis and coding errors.…”

Section: Study Limitationsmentioning

confidence: 99%

Fluoroquinolones and Risk of Aortic Aneurysm or Dissection in Patients With Congenital Aortic Disease and Marfan Syndrome

Chen

Lin

Chan

et al. 2023

Circ J

View full text Add to dashboard Cite

use. 6 Fluoroquinolones are widely used because they have few major complications and are well tolerated by patients; however, they may damage connective tissue collagen and jeopardize the integrity of the extracellular matrix in the vascular wall. Studies have demonstrated that fluoroquinolones significantly increase the risk of AA/AD. 7-10 In Taiwan, fluoroquinolone use has increased from 3.6% in 2000 to 11.5% in 2013. 11 We recently demonstrated that fluoroquinolone exposure in patients with AA/AD was associated with a higher risk of later all-cause mortality, aortic-related death, and later aortic surgery. 11 LeMaire et al also demonstrated that ciprofloxacin, a type of fluoroquinolone, accelerates aortic root enlargement and A ortic aneurysm (AA) and aortic dissection (AD) are acute life-threatening conditions; therefore, identifying risk factors for AA and AD is crucial, particularly in high-risk populations. 1 Marfan syndrome is an autosomal-dominant connective tissue disorder that can lead to aortic enlargement, AA, and AD. 2-4 A recent national database study from Taiwan revealed that approximately 10% of patients with Marfan syndrome developed AD during the follow-up 12 years, and half the patients who developed AD experienced sudden death before the age of 40 years. 5 Fluoroquinolones are among the most commonly used antibiotics in the US, accounting for 5% of total antibiotic

show abstract

Fluoroquinolones Are Associated With Increased Risk of Aortic Aneurysm or Dissection: Systematic Review and Meta-analysis

Cited by 14 publications

References 31 publications

Association Between Fluoroquinolone Use and Hospitalization With Aortic Aneurysm or Aortic Dissection

Association Between Fluoroquinolone Use and Hospitalization With Aortic Aneurysm or Aortic Dissection

Impact on in-hospital mortality of ceftaroline versus standard of care in community-acquired pneumonia: a propensity-matched analysis

Fluoroquinolones and Risk of Aortic Aneurysm or Dissection in Patients With Congenital Aortic Disease and Marfan Syndrome

Contact Info

Product

Resources

About