{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T14:05:51Z","timestamp":1793023551135,"version":"4.5.0"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,3,15]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Fluoroquinolones are first\u2010line 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">We used the National Health Insurance Research Database to identify patients diagnosed with UTIs under single antibiotic treatment of fluoroquinolones and first\u2010, second\u2010, or third\u2010generation 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\u2010 or second\u2010generation cephalosporins. Propensity score matching was performed to reduce the potential for bias caused by measured confounding variables. Among 1\u00a0249\u00a0944 selected patients with UTIs, 28\u00a0568 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\u2010 or second\u2010generation cephalosporins (adjusted HR [aHR], 0.86 [95% CI, 0.59\u20131.27]). However, the mortality increased in the fluoroquinolones group (aHR, 1.10 [95% CI, 1.04\u20131.16]).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Compared with first\u2010 or second\u2010generation 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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.121.023267","type":"journal-article","created":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T11:01:59Z","timestamp":1646132519000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Association Between Aortic Aneurysm and Aortic Dissection With Fluoroquinolones Use in Patients With Urinary Tract Infections: A Population\u2010Based Cohort Study"],"prefix":"10.1161","volume":"11","author":[{"given":"Yin\u2010Yang","family":"Chen","sequence":"first","affiliation":[{"name":"Institute of MedicineChung Shan Medical University Taichung Taiwan"},{"name":"Department of Surgery Chung Shan Medical University Hospital Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0365-7927","authenticated-orcid":false,"given":"Shun\u2010Fa","family":"Yang","sequence":"additional","affiliation":[{"name":"Institute of MedicineChung Shan Medical University Taichung Taiwan"},{"name":"Department of Medical Research Chung Shan Medical University Hospital Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3216-6369","authenticated-orcid":false,"given":"Han\u2010Wei","family":"Yeh","sequence":"additional","affiliation":[{"name":"School of Medicine Chang Gung University Taoyuan City Taiwan"},{"name":"Medical Education Department Chang Gung Memorial Hospital, Linkou Taoyuan City Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6062-7425","authenticated-orcid":false,"given":"Ying\u2010Tung","family":"Yeh","sequence":"additional","affiliation":[{"name":"Graduate School of Dentistry School of Dentistry Chung Shan Medical University Taichung Taiwan"},{"name":"Department of Dentistry Chung Shan Medical University Hospital Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0794-9388","authenticated-orcid":false,"given":"Jing\u2010Yang","family":"Huang","sequence":"additional","affiliation":[{"name":"Institute of MedicineChung Shan Medical University Taichung Taiwan"},{"name":"School of Medicine Chang Gung University Taoyuan City Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao\u2010Lun","family":"Tsao","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering Chung Yuan Christian University Taoyuan Taiwan"},{"name":"Department of Anesthesiology Changhua Christian Hospital Changhua Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3978-5576","authenticated-orcid":false,"given":"Chao\u2010Bin","family":"Yeh","sequence":"additional","affiliation":[{"name":"Institute of MedicineChung Shan Medical University Taichung Taiwan"},{"name":"Department of Emergency Medicine School of Medicine Chung Shan Medical University Taichung Taiwan"},{"name":"Department of Emergency Medicine Chung Shan Medical University Hospital Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","first-page":"361","article-title":"The diagnosis of urinary tract infection: a systematic review","volume":"107","author":"Schmiemann G","year":"2010","unstructured":"Schmiemann G, Kniehl E, Gebhardt K, Matejczyk MM, Hummers\u2010Pradier E. The diagnosis of urinary tract infection: a systematic review. Deutsc Arztebl Int. 2010;107:361\u2013367. doi: 10.3238\/arztebl.2010.0361","journal-title":"Deutsc Arztebl Int"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.12.231"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318169f6ef"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201310-1875OC"},{"key":"e_1_3_2_6_2","first-page":"13","article-title":"EAU guidelines on urological infections 2020","author":"Bonkat GRB","year":"2020","unstructured":"Bonkat GRB, Bruy\u00e8re F, Cai T, Geerlings SE, K\u00f6ves B, Schubert S, Wagenlehner F, Guidelines Associates: Mezei TAP, Pradere B, Veeratterapillay R. EAU guidelines on urological infections 2020. Eur Assoc Urol. 2020; 13\u201322.","journal-title":"Eur Assoc Urol"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1086\/428055"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.2165\/00002018-200932050-00001"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40264-018-0751-2"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.324.7349.1306"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002023"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.5389"},{"key":"e_1_3_2_13_2","article-title":"Fluoroquinolone use and risk of aortic aneurysm and dissection: nationwide cohort study","volume":"360","author":"Pasternak B","year":"2018","unstructured":"Pasternak B, Inghammar M, Svanstr\u00f6m H. Fluoroquinolone use and risk of aortic aneurysm and dissection: nationwide cohort study. BMJ. 2018;360: doi: 10.1136\/bmj.k678","journal-title":"BMJ"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40264-019-00828-z"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2012.07.008"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000001716"},{"key":"e_1_3_2_17_2","article-title":"Population\u2010based study of incidence of acute abdominal aortic aneurysms with projected impact of screening strategy","volume":"4","author":"Howard Dominic PJ","year":"2015","unstructured":"Howard Dominic PJ, Banerjee A, Fairhead JF, Handa A, Silver LE, Rothwell PM. Population\u2010based study of incidence of acute abdominal aortic aneurysms with projected impact of screening strategy. J Am Heart Assoc. 2015;4. doi: 10.1161\/JAHA.115.001926","journal-title":"J Am Heart Assoc"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2020.4192"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S196293"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.017147"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3697"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1080\/00273171.2011.568786"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.06.067"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-020-01354-y"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.44.2.261-266.2000"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1086\/375078"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2006.01.003"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.10617"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.3400\/avd.ctiia09000"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/0741-5214(84)90040-5"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(98)00056-7"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0300-2977(97)00067-3"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1186\/1752-1947-3-6453"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2007.04.017"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2010.02.003"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9838"},{"key":"e_1_3_2_37_2","article-title":"Acute aortic dissection: pathogenesis, risk factors and diagnosis","volume":"147","author":"Gawinecka J","year":"2017","unstructured":"Gawinecka J, Sch\u00f6nrath F, von Eckardstein A. Acute aortic dissection: pathogenesis, risk factors and diagnosis. Swiss Med Wkly. 2017;147: doi: 10.4414\/smw.2017.14489","journal-title":"Swiss Med Wkly"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1104429"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkq465"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-017-1507-0"},{"key":"e_1_3_2_41_2","first-page":"514","article-title":"Primary infected aortic aneurysm: clinical presentation, pathogen, and outcome","volume":"30","author":"Lin CH","year":"2014","unstructured":"Lin CH, Hsu RB. Primary infected aortic aneurysm: clinical presentation, pathogen, and outcome. Acta Cardiologica Sinica. 2014;30:514\u2013521. doi: 10.6515\/acs20140630a","journal-title":"Acta Cardiologica Sinica"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.121.023267","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:39:38Z","timestamp":1715600378000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.121.023267"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,15]]},"references-count":40,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,3,15]]}},"alternative-id":["10.1161\/JAHA.121.023267"],"URL":"https:\/\/doi.org\/10.1161\/jaha.121.023267","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,15]]},"assertion":[{"value":"2021-09-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-01-21","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-03-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e023267"}}