Incidence and Risk Factors for QT Prolongation associated with Fluoroquinolones
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Background : Despite the high bioavailability and broad-spectrum activity of fluoroquinolones (FQs), their administration can lead to corrected QT prolongation. However, there is a lack of information on the incidence and risk factors for FQ-induced long QT in critically ill patients. Our objective is to determine the incidence of QT prolongation and identify the associated risk factors under real-time 24 hour monitoring. Methods : We conducted a retrospective review of medical records of critically ill patients from January to December 2018. In additioon to continuous bedside monitoring with lead II, 12-lead electrocardiography was performed regularly daily and immediately on suspected QT prolongation. The criteria for long QT were defined as QTc ≥ 450 ms for men and ≥ 470 ms for women. Dummy variable regression was performed to analyze QT interval changes before and after QT prolongation, and multivariate logistic regression was performed to identify the risk factors independently associated with QT prolongation. Results : Among 455 admitted patients, FQs were administered in 126 patients (46 female; median age, 77 years [interquartile range=63-81]) and the FQs administerd were levofloxacin (n=43), moxifloxacin (n=35), gemifloxacin (n=15), or ciprofloxacin (n=46). QT prolongation was noted on 119 cases (85.6%) after FQ administraion. The greatest QT interval difference was observed in patients receiving levofloxacin (95% confidence interval [CI]: 36.28–68.62, p < 0.001). The use of loop diuretics (OR: 7.66; 95% CI: 1.12–52.47), co-morbid sepsis (OR: 8.81; 95% CI: 1.18–65.96), and number of medications with known risk of torsade de pointes based on CredibleMeds (OR: 4.83; 95% CI: 1.18–19.79) were identified as independent risk factors. Conclusion : QT prolongation was observed frequently in critically ill patients using FQs. Among the FQs, levofloxacin had the highest incidence of QT interval differences. Therefore, these results suggest that caution is needed when administering FQs in critically ill patients, particularly those with sepsis and those receiving levofloxacin infusion.
Abstract
Background : Despite the high bioavailability and broad-spectrum activity of fluoroquinolones (FQs), their administration can lead to corrected QT prolongation. However, there is a lack of information on the incidence and risk factors for FQ-induced long QT in critically ill patients. Our objective is to determine the incidence of QT prolongation and identify the associated risk factors under real-time 24 hour monitoring. Methods : We conducted a retrospective review of medical records of critically ill patients from January to December 2018. In additioon to continuous bedside monitoring with lead II, 12-lead electrocardiography was performed regularly daily and immediately on suspected QT prolongation. The criteria for long QT were defined as QTc ≥ 450 ms for men and ≥ 470 ms for women. Dummy variable regression was performed to analyze QT interval changes before and after QT prolongation, and multivariate logistic regression was performed to identify the risk factors independently associated with QT prolongation. Results : Among 455 admitted patients, FQs were administered in 126 patients (46 female; median age, 77 years [interquartile range=63-81]) and the FQs administerd were levofloxacin (n=43), moxifloxacin (n=35), gemifloxacin (n=15), or ciprofloxacin (n=46). QT prolongation was noted on 119 cases (85.6%) after FQ administraion. The greatest QT interval difference was observed in patients receiving levofloxacin (95% confidence interval [CI]: 36.28–68.62, p < 0.001). The use of loop diuretics (OR: 7.66; 95% CI: 1.12–52.47), co-morbid sepsis (OR: 8.81; 95% CI: 1.18–65.96), and number of medications with known risk of torsade de pointes based on CredibleMeds (OR: 4.83; 95% CI: 1.18–19.79) were identified as independent risk factors. Conclusion : QT prolongation was observed frequently in critically ill patients using FQs. Among the FQs, levofloxacin had the highest incidence of QT interval differences. Therefore, these results suggest that caution is needed when administering FQs in critically ill patients, particularly those with sepsis and those receiving levofloxacin infusion.
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