Incidence and Predictors of Fluoroquinolone-Associated Adverse Tendon Events among Veterans Affairs Patients with Community Acquired Bacterial Pneumonia

• Published in: Open forum infectious diseases 2017-10, Vol.4 (suppl_1), p.S584-S584
• Main Authors: Patel, Nimish, Clark, Jeffrey, Murray, Jacob, Bowles, Jennifer, Lodise, Thomas P
• Format: Article
• Language: English
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofx163.1528

Abstract Background Fluoroquinolones (FQs) are one of the most widely used antibiotic classes for patients with community acquired bacterial pneumonia (CABP). Despite their frequent use, there are emerging safety concerns highlighted by the FDA. One of the more problematic adverse events are tendinopathy and tendon rupture. The objectives of this study were to 1) quantify the incidence and 2) identify the predictors of FQ-associated adverse tendon events (FQATE) among Veterans Affairs (VA) patients with CABP. Methods A retrospective cohort study was performed among VA patients from the Upstate New York Veterans’ Healthcare Administration. Inclusion criteria: (1) age ≥18 years, (2) diagnosis of CABP (initial ICD9 code followed by manual confirmation) from January 2014 to December 2015, (3) receipt of IV or oral FQ ≥ 1 day, and (4) treatment initiated while pt inpatient. Demographics, comorbidities, laboratory values, treatment history, course of hospitalization and outcomes were collected from pt’s medical records. Occurrence of FQATE was defined using a natural word search algorithm of patients’ clinical progress notes within 90 days of starting FQ therapy. Word search terms were: tendinopathy, tendon pain, tendon rupture, tendinitis, and Achilles heel pain/tear/torn/rupture. Multivariable statistics were used to determine predictors of FQATE. Results Among the 379 patients included, most were male (96.0%) and mean (SD) age was 73.0 (12.7) yrs. Mean (SD) APACHE-II was 10.2 ± 5.1 and 18% were admitted to an ICU. Levofloxacin (52.8%) was most commonly used, followed by moxifloxacin (41.2%) and ciprofloxacin (6.1%). Median (IQR) duration of therapy was 4 (2 – 7) days. Inappropriate renal dose adjustment was present in 55 (14.5%) patients. There were 9 (2.4%) patients with FQATE occurring after a median (IQR) of 21 (6 – 70) days since starting FQ therapy. Two patients had multiple FQATE terms. Most frequent terms were tendinitis (55.6%), tendon pain (22.2%), Achilles heel pain (22.2%), tendinopathy (11.1%), tendon rupture (11.1%) and none for Achilles heel tear/torn/rupture. None of the cases of FQATE died within the 90 day observation period. Body mass index (BMI) ≥ 30 was the only variable significantly associated with FQATE in multivariable analyses adjusting for duration of therapy and osteoarthritis. Conclusion Incidence of FQATE was 2.4% among VA patients and predicted by BMI ≥ 30. Disclosures N. Patel, Gilead Sciences, Inc.: Grant Investigator, Research