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

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 Aas and for ruptured Aas 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 Aas (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.

Automated summary

This study examined the risk of aortic aneurysm after short-term ciprofloxacin as prophylaxis for prostate biopsy, and found that short-term ciprofloxacin was not associated with an increased risk of aortic aneurysm. However, an increased risk of aortic aneurysm was observed in men diagnosed with high-risk prostate cancer, likely due to detection bias caused by more commonly performed imaging in these men.