ABSTRACT
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.
ABSTRACT
PURPOSE: Evaluation of the clinical impact of a pharmacist led-penicillin allergy assessment initiative to enhance antibiotic selection is reported. METHODS: A retrospective analysis was conducted on patients with a self-reported penicillin allergy (SRPA) at a 529-bed community teaching hospital and compared clinical response rate before and after implementation of a penicillin allergy assessment initiative, consisting of pharmacy staff education and pocket card development. Patients admitted with SRPA who received antibiotics with gram-negative coverage for at least 48 hours were included. The primary outcome was the clinical response rate of penicillin-allergic patients determined preimplementation and postimplementation of the initiative and was based upon improvement in signs and symptoms of infection. Secondary outcomes included antibiotics used, antibiotic durations, length of stay, survival rate, antibiotic discontinuation rate, and Clostridium difficile infection rate. RESULTS: A total of 280 patients were reviewed. Clinical response rate improved after implementation of the initiative (p = 0.047). There were significant differences in the type of antibiotics prescribed between the preimplementation group and the postimplementation group: increased cephalosporin use (p < 0.001), decreased aztreonam use (p = 0.017), and lower fluoroquinolone use (p = 0.008). Median length of stay (p = 0.943), in-hospital mortality rate (p = 0.173), and C. difficile infection rate (p = 0.426) were similar before and after implementation of the initiative. CONCLUSION: After implementation of an initiative to encourage the use of cephalosporins rather than aztreonam in patients with SRPA, the rate of clinical response and cephalosporin use increased and rates of exposure to aztreonam and fluoroquinolones decreased.
