Systematic Literature Review on the Impact of Hospitalisation and Associated Complications on Patients with Bacterial Infections Receiving Intravenous Antibiotics

Hospitalisation, which carries a risk of hospital-acquired complications (HAC), is common for intravenous (IV) antibiotic treatment and is recommended for serious infections, including complicated urinary tract infections (cUTI). We conducted two systematic literature reviews (SLR) to evaluate IV-line complications (IVLC) associated with short-term IV antibiotic treatment in patients with bacterial infections and assess hospitalisation-related and hospital-acquired complications (including infections). Studies of patients hospitalised with any bacterial infection treated with short-term (≤ 30 days) IV antibiotics, published during 2013–2023, were identified in MEDLINE, Embase and other sources. SLR1 included prevalence and incidence rate of IVLC and impact on outcomes and healthcare resource utilisation (HCRU). SLR2 included prevalence of HAC, length of stay (LOS), readmission and costs. In SLR1 (36 primary studies), median prevalence and incidence rate of any IVLC for all patients were 6.1% (18 studies) and 3.4 per 1000 catheter/outpatient antimicrobial treatment-days (7 studies), respectively. In patients with cUTI, median prevalence of any IVLC was 1.7% (1 study). Prevalence of IVLC was lower in patients who transitioned from IV-to-oral antibiotics versus IV cohort (5 studies). IVLC increased HCRU, including rehospitalisation, LOS, emergency department visits and IV-line replacement. In SLR2 (36 primary studies), median prevalence of HAC (25 studies) ranged from 0.2% (UTI) to 11.5% (fall) and for hospital-acquired infections in patients with cUTI (5 studies) from 0.2% (Clostridium difficile infection) to 5.4% (new infection). In all patients, each additional day in hospital was associated with a 1.4–1.6% increase in the probability of a hospital-acquired infection, while having a HAC increased LOS by up to 28 days (range: 0–28 days; 12 studies) and was associated with readmission and additional healthcare costs. Hospital-acquired complications, including IVLC, are common and associated with increased HCRU among patients receiving < 30 days of IV antibiotics for bacterial infections. Patients with serious bacterial infections often need to stay in hospital for treatment with intravenous antibiotics. Whilst staying in the hospital, the patient may develop other infections or complications with the intravenous line. This may result in the patient having to stay in the hospital for longer, being readmitted or having their intravenous line replaced. To understand how common these problems are and how they affect patients, we assessed studies published between 2013 and 2023 that focussed on patients who were in the hospital for up to 30 days and received intravenous antibiotics. These studies showed that patients who switched from intravenous antibiotics to oral antibiotics had fewer intravenous-line complications. The longer a patient stayed in the hospital, the more likely they were to get a new infection; each extra day increased the risk of hospital-acquired infection by about 1–2%. Patients with these complications may need to stay in the hospital for up to an additional 28 days, be at risk of more complications (e.g. intravenous -line blockages, urinary tract infections and falls) and subsequently need more healthcare, resulting in higher medical costs.