IV antibiotics associated with worse outcomes in patients with heart failure
Patients with acute decompensated heart failure who were treated with IV antibiotics — without evidence of infection — experienced longer hospital stays, required more diuretics and were more likely to be readmitted compared with patients with acute decompensated heart failure who were not exposed to IV antibiotics, researchers reported in Clinical Infectious Diseases.
“Both [acute decompensated heart failure, or ADHF] and [community-acquired pneumonia] may present as acute dyspnea and making a definitive diagnosis of one vs. the other can be a challenge,” Mark S. Rasnake, MD, internal medicine program director at the University of Tennessee College of Medicine, and colleagues wrote. “In many cases, the two conditions are simultaneously present in the same patient, and other studies have demonstrated that a large proportion of ADHF patients are concurrently treated for suspected pneumonia.”
Rasnake and colleagues conducted a retrospective analysis of 144 adult patients aged 18 years or older with ADHF who were at a low risk for pneumonia based on diagnostic findings and clinical documentation at a single center, level one trauma center. The primary endpoint was length of stay, and secondary outcomes included mortality, readmission rates, amount of diuretic received and fluid volume and quantity of sodium administered as part of IV antibiotic therapy.
According to the study, 56 patients with ADHF received IV antibiotics upon admission and the other 88 patients did not. Patients treated with IV antibiotics received an average of 1.7 L of additional fluid and 9,311 mg of additional sodium compared with patients not treated with IV antibiotics. Patients receiving IV antibiotics had a significantly longer length of stay (6.6 days) compared with patients not exposed to IV antibiotics (3 days; P < .001). Moreover, patients treated with IV antibiotics required higher total doses of furosemide compared with those not treated with IV antibiotics, 930 mg vs. 320 mg (P < .001). And readmission was 2.51 times more likely among patients who received IV antibiotics (P = .04).
The researchers noted that this patient population may be a “promising target” for antibiotic stewardship.
“This article presents a novel approach to making an antibiotic stewardship push to non-ID clinicians,” Rasnake told Infectious Disease News. “Certain patient populations, such as patients with heart failure, can be very susceptible to harm from excess fluid volume and sodium. We wanted to explore another potential harm of potentially inappropriate IV antibiotic therapy, and intend to explore this work further in a prospective antibiotic stewardship intervention at our facility.” – by Marley Ghizzone
Disclosures: The authors report no relevant financial disclosures.