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

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.