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Impact of Radiography on Antibiotic Prescribing Practices in Patients with Acute Decompensated Heart Failure

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Abstract

Chest radiography findings can be similar in acute decompensated heart failure (ADHF) and pneumonia. Prescriber discretion is needed to avoid unnecessary antibiotics and subsequent fluid administration. This study was conducted at a tertiary, community, teaching hospital in the USA. This retrospective cohort study included adults admitted with ADHF without overt signs of infection or comorbidities that mimic pneumonia (e.g., chronic lung disease). Patients were placed into two cohorts based on radiology interpretation: a control cohort with radiograph report without mention of infection or a positive cohort with infection considered in the differential. The primary outcome was percentage of patients prescribed antibiotics. Secondary outcomes included total antibiotic days, length of stay, and volume of fluid administered from antibiotics. There were 127 patients included, 39 in the positive cohort and 88 in the control. Baseline characteristics were similar. Incidence of antibiotic use was 30.8% in the positive cohort compared to 10.2% in the control cohort (p = 0.008). Antibiotic days were significantly higher in the positive cohort compared to the control (44.4% vs. 9.4%, respectively, p < 0.001). Median length of stay was similar between groups. Patients prescribed antibiotics during ADHF received an average of 633 mL of extra intravenous fluid over the course of their admission. Clinical discretion is critical when interpreting chest radiograph reports in ADHF. Antibiotic overprescribing in this population presents a significant opportunity for antibiotic stewardship and improvement to ADHF care.

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Data can be made available upon request.

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Authors and Affiliations

  1. Department of Pharmacy, Johnson City Medical Center, 400 North State of Franklin Road, Johnson City, TN, 37604, USA

    Samantha N. Rodriguez & Paul O. Lewis

  2. Department of Infectious, Inflammatory and Immunologic Diseases, East Tennessee State University Quillen College of Medicine, Johnson City, Tennessee, 37614, USA

    Matthew A. Krolikowski

  3. Emergency Department, Johnson City Medical Center, Johnson City, TN, USA

    Garik T. Misenar

Authors
  1. Samantha N. Rodriguez
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  2. Matthew A. Krolikowski
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  3. Garik T. Misenar
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  4. Paul O. Lewis
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Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; contributed to the drafting of the article or revising it critically for important intellectual content; and have given final approval of the version to be published.

Corresponding author

Correspondence to Paul O. Lewis.

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Ethics Approval

This study was approved by the Institutional Review Board at East Tennessee State University and by the Ballad Health research department. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Not applicable.

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All authors give consent for the publication of this article and associated tables and graphics to be published in the above Journal.

Competing Interests

Paul Lewis is an employee of Syneos Health on behalf of GlaxoSmithKline. All other authors declare no competing interests.

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Impact of findings on practice

Simultaneous treatment of pneumonia and ADHF is common

Clinical discretion is critical when interpreting chest radiograph reports in ADHF

Fluid stewardship with regard to heart failure management should accompany antibiotic stewardship in clinical practice

This article is part of the Topical Collection on Medicine

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Rodriguez, S.N., Krolikowski, M.A., Misenar, G.T. et al. Impact of Radiography on Antibiotic Prescribing Practices in Patients with Acute Decompensated Heart Failure. SN Compr. Clin. Med. 3, 1898–1903 (2021). https://doi.org/10.1007/s42399-021-00969-2

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