Short-term ciprofloxacin prophylaxis for prostate biopsy and risk of aortic aneurysm. Nationwide, population-based cohort study

Abstract

Introduction

The use of quinolones has recently been questioned due to reports on side effects including an increased risk of aortic aneurysm. The aim of the study was to examine the risk of aortic aneurysm (AA) after short-term ciprofloxacin as prophylaxis for prostate biopsy.

Materials and Methods

We used the Prostate Cancer data Base Sweden and investigated 192,024 prostate biopsy exposures vs. 554,974 non-exposures for risk of AA.

Prostate biopsy was used as a proxy for quinolone use as short-term ciprofloxacin is the recommended and documented prophylaxis in Sweden for this procedure.

The outcome was the hazard ratio (HR) of AA in men who underwent a biopsy vs. those that did not.

Results

The absolute risk of AA was small, 39/10,000 person years for all AÁs and for ruptured AÁs 3.5/10,000 person years. In multivariate analyses, there were small, non-significant increases in risk of all AA’s (adjusted HR = 1.13, 95% CI: 0.91 to 1.39) and ruptured AÁs (adjusted HR = 1.05, 95% CI: 0.52 to 2.15) in men who underwent biopsy. A significantly increased risk of AA was observed in men diagnosed with high-risk prostate cancer on biopsy (HR = 1.50, 95% CI: 1.15–2.21). The use of prostate biopsy as a proxy for exposure to ciprofloxacin was a limitation of the study.

Conclusions

Short-term ciprofloxacin was not associated with an increased risk of aortic aneurysm and the increased risk in men with high-risk prostate cancer was likely due detection bias caused by imaging more commonly performed in these men.

Keywords:

• Prostate biopsy
• ciprofloxacin
• aortic aneurysm
• prophylaxis

Acknowledgements

This project was made possible by the continuous work of the National Prostate Cancer Register of Sweden (NPCR) steering group: Pär Stattin (chairman), Ingela Franck Lissbrant (co-chair), Camilla Thellenberg, Eva Johansson, Lennart Åström, Magnus Törnblom, Stefan Carlsson, Marie Hjälm Eriksson, David Robinson, Mats Andén, Ola Bratt, Jonas Hugosson, Maria Nyberg, Per Fransson, Johan Styrke, Hampus Nugin, Olof Ståhl, Thomas Jiborn, Olof Akre, Johan Stranne, Eva Johansson, Fredrik Jäderling, Fredrik Sandin, Karin Hellström, Gert Malmberg and Hans Joelsson.

Disclosure statement

None declared. Rolf Gedeborg is also employed by the Medical Products Agency (MPA) in Sweden. The MPA is a Swedish Government Agency. The views expressed in this article may not represent the views of the MPA.

A study protocol was prepared before data collection but not registered before analysis

Data availability statement

Data used in the present study was extracted from the Prostate Cancer data Base Sweden 4.1. For information on data access and code used contact the corresponding author.

Additional information

Funding

The study was supported by grants from Västernorrland County Council and the Swedish Research Council [2017-00847].