A recent analysis involving over 85,000 patients found that intravenous (IV) iron treatment improved survival rates and increased hemoglobin levels in individuals with iron-deficiency anemia who were hospitalized due to acute bacterial infections. The study was conducted by Dr. Haris Sohail and colleagues, who reviewed de-identified patient data from medical centers across the United States for adults treated between 2000 and 2024.
IV iron is commonly used to treat severe iron-deficiency anemia. However, its use in patients with concurrent acute bacterial infection has been debated. "Studies have shown that in laboratory experiments, certain bacteria can multiply when iron is added," said Dr. Sohail. He noted that while this effect has not been confirmed in human studies, clinical guidelines have generally advised against administering IV iron during active bacterial infections due to concerns about worsening infection.
The research team collected information on patients hospitalized with the five most common acute bacterial infections: pneumonia (over 27,000 cases), urinary tract infections (over 23,000), methicillin-resistant staphylococcus aureus (MRSA; over 15,000), cellulitis (over 13,000), colitis (over 7,000), and a smaller group with bacterial meningitis (143 cases).
Outcomes were compared between those who received IV iron and those who did not. The analysis focused on mortality within 14 or 90 days of hospitalization, length of hospital stay, and changes in hemoglobin levels measured at 60 to 90 days after treatment.
Results indicated that for all infections except meningitis, patients given IV iron had statistically significant lower mortality at both time points and greater increases in hemoglobin than those who did not receive the treatment. In the case of meningitis, IV iron neither improved nor worsened outcomes.
"The survival benefit of IV iron was seen across different types of infections, with the biggest improvements seen in patients with pneumonia, MRSA bacteria in the blood, and colitis," Dr. Sohail said. He also mentioned that although recipients of IV iron stayed slightly longer—by about four to six hours—in the hospital compared to others, this difference was not considered clinically important.
Dr. Sohail explained that the limited number of meningitis cases may account for why results for this subgroup were not statistically significant. He also cautioned that as a retrospective review of past patient records, the study could only identify associations rather than prove causation. Additional limitations included lack of detailed data on specific bacteria or exact doses of administered iron; thus findings are most relevant to hospitalized patients with both conditions present.
"Our findings support consideration of the use of IV iron as a safe additional therapy for patients who are hospitalized with both iron-deficiency anemia and an acute bacterial infection," Dr. Sohail stated. He suggested further confirmation through randomized controlled trials.
Dr. Haris Sohail will present these results on December 7, 2025 at a plenary scientific session at the Orange County Convention Center.
