{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T14:00:05Z","timestamp":1792159205998,"version":"4.4.0"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"<jats:sec id=\"ab-hbr230014-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Fluoroquinolone use has been associated with increased hospitalization with aortic aneurysm or dissection in noninterventional studies, but the reason for this observed association is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr230014-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the association between fluoroquinolone use and aortic aneurysm or dissection using multiple study designs and multiple databases to increase the robustness of findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr230014-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>Cohort 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr230014-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Systemic fluoroquinolone or comparator antibiotic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr230014-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Hazard 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr230014-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the cohort study, we identified 3\u202f134\u202f121 adults in Aurum (mean [SD] age, 52.5 [20.3] years; 1\u202f969\u202f257 [62.8%] female) and 452\u202f086 in GOLD (mean [SD] age, 53.9 [20.2] years; 286\u202f502 [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;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001) but after adjustment for potential confounders, this association disappeared (pooled adjusted HR, 1.03; 95% CI, 0.91-1.17;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.65). In the case-crossover study, we identified 84\u202f841 individuals hospitalized with aortic aneurysm or dissection in Aurum (mean [SD] age, 75.5 [10.9]; 23\u202f551 [27.8%] female) and 10\u202f357 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).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr230014-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>The 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamacardio.2023.2418","type":"journal-article","created":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T11:01:25Z","timestamp":1692183685000},"page":"865","source":"Crossref","is-referenced-by-count":30,"title":["Association Between Fluoroquinolone Use and Hospitalization With Aortic Aneurysm or Aortic Dissection"],"prefix":"10.1001","volume":"8","author":[{"given":"Jeremy P.","family":"Brown","sequence":"first","affiliation":[{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Wing","sequence":"additional","affiliation":[{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cl\u00e9mence","family":"Leyrat","sequence":"additional","affiliation":[{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom"},{"name":"Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn E.","family":"Mansfield","sequence":"additional","affiliation":[{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angel Y. S.","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liam","family":"Smeeth","sequence":"additional","affiliation":[{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas W.","family":"Galwey","sequence":"additional","affiliation":[{"name":"Research and Development, GSK Medicines Research Centre, GSK, Stevenage, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian J.","family":"Douglas","sequence":"additional","affiliation":[{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United 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