From the Guidelines
Intravenous (IV) iron should be avoided in patients with active bacteremia due to the increased risk of infection associated with its administration, as evidenced by a systematic review and meta-analysis published in 2021 1. This recommendation is based on the fact that iron is an essential nutrient for bacterial growth and virulence, and its administration during active infection can potentially worsen the infection by providing bacteria with readily available iron that supports their proliferation and enhances their virulence factors. Some key points to consider when deciding to administer IV iron in patients with a history of bacteremia include:
- Postponing IV iron administration until the bacteremia has been adequately treated and resolved, typically after a full course of appropriate antibiotics and documented negative blood cultures.
- Selecting the specific IV iron preparation based on the patient's clinical situation, with appropriate dosing calculated according to the patient's weight and hemoglobin deficit.
- Monitoring patients closely during and after administration for potential adverse reactions, including hypersensitivity reactions, which can range from mild to severe, as cautioned in guidelines for patients with acute or chronic infection 1. Additionally, it is crucial to weigh the potential benefits of treating anemia and reducing blood transfusion requirements against the potential risks of infection associated with IV iron administration, as highlighted in the 2021 systematic review and meta-analysis 1.
From the Research
IV Iron Therapy in Bacteremic Patients
- The use of intravenous (IV) iron in patients with bacterial infections is a topic of interest, with some studies suggesting that it may be safe in certain clinical subgroups 2.
- A retrospective chart review of 197 patients who received IV iron sucrose and antibiotics during the same admission found that most patients did not have negative outcomes, with only 2% having antibiotic therapy broadened or duration extended, 7% dying, and 16% being readmitted within 30 days of discharge 2.
- However, other studies have raised concerns about the potential risk of infection with IV iron therapy, citing the role of iron in bacterial growth and the pathophysiology of cellular immunity 3, 4.
- The mechanisms of iron uptake by bacteria are complex, involving siderophores and other iron-chelating molecules, and have been targeted in the development of siderophore-conjugated antibiotics 5.
- The relationship between iron deficiency, anemia, and susceptibility to infections is also complex, with iron being essential for both host immune function and pathogen growth 6.
Clinical Considerations
- Healthcare providers may hesitate to use IV iron in patients with bacterial infections due to concerns about the potential risk of infection 2.
- Careful consideration of the risk-benefit ratio is necessary when administering IV iron to patients with ongoing infection 3.
- Further research is needed to determine the safety and efficacy of IV iron therapy in patients with bacterial infections, particularly in different clinical subgroups 2, 3.