Impact of intravenous antibiotics for unconfirmed pulmonary infections in patients with acute decompensated heart failure at a community health system

Purpose Patients with acute decompensated heart failure (ADHF) present similarly to those with respiratory infections, which may lead to administration of unnecessary intravenous (IV) antibiotics. This study was conducted to assess outcomes in patients admitted for ADHF who received IV antibiotics vs those who did not. Methods This retrospective cohort study evaluated adults admitted with ADHF who received IV antibiotics for at least 48 hours or did not receive IV antibiotics. Patients with an active infection were excluded. The primary outcome was hospital length of stay in the unmatched cohort; secondary outcomes included 30-day readmission, all-cause mortality, amount of loop diuretic administered, total sodium and fluids received, Clostridioides difficile infection, IV antibiotic agents administered, and duration of therapy. Results The unmatched cohort included 38 patients who received IV antibiotics and 123 patients who did not receive IV antibiotics, while the matched cohort included 33 patients in each arm. In the unmatched and matched cohorts, patients receiving IV antibiotics had a longer median hospital length of stay (5 vs 3 days; P < 0.01 and 5 vs 4 days; P < 0.01) and received a greater median amount of total sodium (9.22 vs 0.28 g; P < 0.01 and 10.24 vs 0 g; P < 0.01) and median total volume from IV antibiotics and fluids (1,788 vs 50 mL; P < 0.01 and 1,825 vs 0 mL; P < 0.01). No significant differences were found for the other secondary outcomes. Ceftriaxone and azithromycin were the most frequently administered IV antibiotics, with a median duration of therapy of 4 days. Conclusion Use of IV antibiotics in patients with ADHF was associated with longer hospital length of stay and should be avoided in patients without evidence of infection.