BACKGROUND: Acute decompensated heart failure (ADHF) can present similarly to pulmonary infections. The additional volume and sodium received from intravenous antibiotics (IVAB) can be counterproductive, especially when strong evidence of infection is lacking. OBJECTIVE: The objective was to evaluate the impact of potentially unwarranted IVAB on clinical outcomes in patients with ADHF. METHODS: This multicenter, retrospective, cohort study evaluated adults admitted with ADHF, a chest radiograph within 24 hours, B-natriuretic peptide >100 pg/mL, and either received no IVAB or IVAB for at least 48 hours. Subjects with recent antibiotics, justification for antibiotics, or transferred to the intensive care unit (ICU) within 24 hours of admission were excluded. The primary outcome was hospital length of stay (LOS). Secondary outcomes included utilization of loop diuretics, administration of fluid and sodium, mortality, and 30-day readmissions. RESULTS: Out of 240 subjects included, 120 received IVAB. LOS was significantly longer in the IVAB group (5.12 days vs 3.73 days; P < .001). LOS remained significantly longer in the IVAB group in a propensity score matched cohort (5.26 days vs 3.70 days; P < .001). The IVAB group received more volume and sodium from intravenous fluids (P < .001). ICU admission greater than 24 hours after admission was higher with IVAB (20% vs 7.5%; P = .049). No significant differences in total loop diuretics, intubation rate, mortality, and 30-day readmissions were identified. CONCLUSION: ADHF patients who received potentially unwarranted IVAB had longer hospital LOS and were more likely to be admitted to the ICU after 24 hours of hospitalization.
BACKGROUND: Acute decompensated heart failure (ADHF) can present similarly to pulmonary infections. The additional volume and sodium received from intravenous antibiotics (IVAB) can be counterproductive, especially when strong evidence of infection is lacking. OBJECTIVE: The objective was to evaluate the impact of potentially unwarranted IVAB on clinical outcomes in patients with ADHF. METHODS: This multicenter, retrospective, cohort study evaluated adults admitted with ADHF, a chest radiograph within 24 hours, B-natriuretic peptide >100 pg/mL, and either received no IVAB or IVAB for at least 48 hours. Subjects with recent antibiotics, justification for antibiotics, or transferred to the intensive care unit (ICU) within 24 hours of admission were excluded. The primary outcome was hospital length of stay (LOS). Secondary outcomes included utilization of loop diuretics, administration of fluid and sodium, mortality, and 30-day readmissions. RESULTS: Out of 240 subjects included, 120 received IVAB. LOS was significantly longer in the IVAB group (5.12 days vs 3.73 days; P < .001). LOS remained significantly longer in the IVAB group in a propensity score matched cohort (5.26 days vs 3.70 days; P < .001). The IVAB group received more volume and sodium from intravenous fluids (P < .001). ICU admission greater than 24 hours after admission was higher with IVAB (20% vs 7.5%; P = .049). No significant differences in total loop diuretics, intubation rate, mortality, and 30-day readmissions were identified. CONCLUSION: ADHF patients who received potentially unwarranted IVAB had longer hospital LOS and were more likely to be admitted to the ICU after 24 hours of hospitalization.
Authors: M S Niederman; L A Mandell; A Anzueto; J B Bass; W A Broughton; G D Campbell; N Dean; T File; M J Fine; P A Gross; F Martinez; T J Marrie; J F Plouffe; J Ramirez; G A Sarosi; A Torres; R Wilson; V L Yu Journal: Am J Respir Crit Care Med Date: 2001-06 Impact factor: 21.405
Authors: Patricia P Chang; Lisa M Wruck; Eyal Shahar; Joseph S Rossi; Laura R Loehr; Stuart D Russell; Sunil K Agarwal; Suma H Konety; Carlos J Rodriguez; Wayne D Rosamond Journal: Circulation Date: 2018-03-08 Impact factor: 29.690
Authors: Paul A Heidenreich; Nancy M Albert; Larry A Allen; David A Bluemke; Javed Butler; Gregg C Fonarow; John S Ikonomidis; Olga Khavjou; Marvin A Konstam; Thomas M Maddox; Graham Nichol; Michael Pham; Ileana L Piña; Justin G Trogdon Journal: Circ Heart Fail Date: 2013-04-24 Impact factor: 8.790
Authors: Klaus F Rabe; Suzanne Hurd; Antonio Anzueto; Peter J Barnes; Sonia A Buist; Peter Calverley; Yoshinosuke Fukuchi; Christine Jenkins; Roberto Rodriguez-Roisin; Chris van Weel; Jan Zielinski Journal: Am J Respir Crit Care Med Date: 2007-05-16 Impact factor: 21.405