IV Iron Largely Safe for Patients with Acute Bacterial Infection

Credit: Marcelo Leal/Unsplash

Intravenous (IV) iron was not associated with negative outcomes among patients hospitalized with acute bacterial infection, according to findings from a retrospective chart review.¹

Based on hospital admission data, the analysis showed IV iron is commonly prescribed and administered for anemia treatment after acute bacterial infection, including in many older adults.

“The risk of administering IV iron during an acute infection remains unknown and must be weighed against the risks of untreated iron-deficiency anemia (IDA),” wrote the investigative team, led by Nicole Centanni, PharmD, Maine Medical Center.

A top cause of global disability burden, particularly in women, iron deficiency cause be caused by a multitude of factors, including higher iron requirements, low iron intake, and chronic blood loss.² Most clinical guidelines define IDA in populations without chronic kidney disease (CKD) as a serum ferritin level of 100 µg/L.³

Leaving IDA untreated can both reduce physical performance and quality of life in adults and lead to cognitive decline and higher mortality in older people. IV iron therapy is guideline recommended for patients with heart failure, CKD, and colitis, and has been shown to reduce the need for blood transfusions in specific populations.⁴

However, there are noted uncertainties regarding IV iron therapy and the potential for infection.¹ Physicians may hesitate to use IV iron therapy to treat hospitalized patients with bacterial infections. Centanni and colleagues examined IV iron prescription patterns for bacterial infection hospitalizations and the associated clinical outcomes in the current study.

All patients aged ≥18 who received both iron sucrose and antibiotics during admission at Maine Medical Center in 2019 were enrolled in the retrospective chart review analysis.

Outcome measures included mortality during hospital admission, mortality and/or readmission within 30 days of discharge, receipt of blood transfusion, fever status surrounding IV iron, and duration and scope of antibiotic treatment.

A total of 443 patients who received both IV iron and antibiotics during the same hospital admission were screened and 197 (45%) patients were evaluated. Patients had a mean age of 67.9 years, half (52%) were male, and the median length of stay was 9 days. Notably, the most frequent infection categories were respiratory (33%) or urinary tract (24%) infections.

Overall, 23 of 165 (14%) patients had serum ferritin levels >500 ng/mL, including 8 (5%) with levels >1000 ng/mL. For the population, the median duration of antibiotic therapy was 5 days.

Administration of antibiotic and iron sucrose therapy overlapped in 153 (77.7%) patients for a mean duration of 2.7 days. For the 44 patients without overlap, 24 (55%) received antibiotic therapy first with a median gap of 1 day, and 20 (46%) received iron before antibiotics with a median gap of 2 days.

An investigation into clinical outcomes revealed that 14 (7%) patients died within 30 days of discharge, with 71% of deaths appearing unrelated to infection. Among 32 (16%) readmissions within 30 days, 22 (69%) were deemed unrelated to an infectious cause, while 3 (9%) experienced worsening of the original infection.

However, only 5 (2.5%) patients had an extended duration, and 4 (2%) experienced widened antibiotic therapy after IV iron therapy.

Centanni and colleagues called for further studies to evaluate the risk of worsening infection in hospitalizations provided IV iron, and whether factors including ferritin can predict the safety of IV iron in these contexts.

“Although our findings support that IV iron treatment is safe among patients with concomitant infection and iron deficiency, this safety may not be the case for all clinical subgroups” they added.

References

1. _{Centanni N, Hammond J, Carver J, Craig W, Nichols S. Intravenous Iron in Patients Hospitalized with Bacterial Infections: Utilization and Outcomes. J Maine Med Cent. 2024;6(2):1. doi:10.46804/2641-2225.1176}
2. _{Camaschella C. Iron deficiency [published correction appears in Blood. 2023 Feb 9;141(6):682. doi: 10.1182/blood.2022018610]. Blood. 2019;133(1):30-39. doi:10.1182/blood-2018-05-815944}
3. _{Peyrin-Biroulet L, Williet N, Cacoub P. Guidelines on the diagnosis and treatment of iron deficiency across indications: a systematic review. Am J Clin Nutr. 2015;102(6):1585-1594. doi:10.3945/ajcn.114.103366}
4. _{Litton E, Xiao J, Ho KM. Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials. BMJ. 2013;347:f4822. Published 2013 Aug 15. doi:10.1136/bmj.f4822}