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Abstract
This study aimed to address the association between the usage of antibiotics to treat nontuberculous mycobacteria (NTM) infection and the risk of Sjögren’s syndrome (SS). We identified 5,553 patients with newly diagnosed SS between 2002 and 2013 using Taiwan’s National Health Insurance Research Database and compared them with 83,295 non-SS controls matched (1:15) for age, sex, and the year of their first SS diagnosis. An increased risk of SS was found in patients receiving new macrolides (adjusted odds ratios (aOR) 1.95, 95% confidence intervals (CI) 1.80–2.11), fluoroquinolones (aOR 1.52, 95% CI 1.41–1.64), and tetracyclines (aOR 1.69, 95% CI 1.59–1.79) compared with non-SS controls after adjusting for the Charlson comorbidity index, bronchiectasis and Helicobacter pylori infection. Notably, the association was consistent among each antibiotic in these three groups of antibiotics. In contrast to these three groups of antibiotics, the use of amikacin tended to have a negative association with incident SS (aOR 0.68, 95% CI 0.53–0.87). In conclusion, new macrolides, fluoroquinolones and tetracyclines were associated with a higher incidence of SS. These findings indicate the need for vigilance of SS in prescribing these antibiotics and warrant further mechanistic studies.
Highlights
Age, years Age group ≤40 years 40–65 years ≥65 years Gender Female Male Charlson comorbidity index (CCI) CCI group 0 ≥1 Bronchiectasis History of H. pylori infectiona
We found that s syndrome (SS) case subjects had a slightly higher CCI (0.5 ± 0.9 vs. 0.4 ± 1.0, p < 0.001) and were more likely to have bronchiectasis (3.6% vs. 1.1%, p < 0.001) and H. pylori infection (0.9% vs. 0.3%, p < 0.001) than controls (Table 1)
Sinusitis, bronchitis and vaginitis/vulvovaginitis were major indications for tetracyclines; pneumonia, urinary tract infection, sinusitis and unspecified respiratory infection were major indications for the four FQNs; and H. pylori infection, pneumonia and bronchitis were major indications for new macrolides (Supplementary Table 1)
Summary
Years (mean ± SD) Age group ≤40 years 40–65 years ≥65 years Gender Female Male CCI CCI group 0 ≥1 Bronchiectasis History of H. pylori infectiona. We recently reported an association between SS and prior nontuberculous mycobacterial (NTM) infection, which was defined as a diagnosis of NTM with concurrent combinational antibiotic therapy for NTM infection[8]. Whether the increased risk of SS was due to NTM infection or the antibiotics used to treat NTM infection is unknown. Given that combination antibiotic therapy is the fundamental strategy employed to treat NTM infections, antibiotic-associated SS might contribute to the development of SS. We aimed to address the association between the use of antibiotics that are generally administered for NTM infection and the risk of newly diagnosed SS using a nationwide, population-based cohort
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