{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T07:54:04Z","timestamp":1793433244936,"version":"4.5.0"},"reference-count":208,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi210958-4\"><jats:title>Importance<\/jats:title><jats:p>Intravenous iron is recommended by many clinical guidelines based largely on its effectiveness in reducing anemia. However, the association with important safety outcomes, such as infection, remains uncertain.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi210958-5\"><jats:title>Objective<\/jats:title><jats:p>To examine the risk of infection associated with intravenous iron compared with oral iron or no iron.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi210958-6\"><jats:title>Data Sources<\/jats:title><jats:p>Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for randomized clinical trials (RCTs) from 1966 to January 31, 2021. Ongoing trials were sought from ClinicalTrials.gov, CENTRAL, and the World Health Organization International Clinical Trials Search Registry Platform.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi210958-7\"><jats:title>Study Selection<\/jats:title><jats:p>Pairs of reviewers identified RCTs that compared intravenous iron with oral iron or no iron across all patient populations, excluding healthy volunteers. Nonrandomized studies published since January 1, 2007, were also included. A total of 312 full-text articles were assessed for eligibility.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi210958-8\"><jats:title>Data Extraction and Synthesis<\/jats:title><jats:p>Data extraction and risk of bias assessments were performed according to the Preferred Reporting Items of Systematic Reviews and Meta-analyses (PRISMA) and Cochrane recommendations, and the quality of evidence was assessed using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach. Two reviewers extracted data independently. A random-effects model was used to synthesize data from RCTs. A narrative synthesis was performed to characterize the reporting of infection.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi210958-9\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was risk of infection. Secondary outcomes included mortality, hospital length of stay, and changes in hemoglobin and red blood cell transfusion requirements. Measures of association were reported as risk ratios (RRs) or mean differences.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi210958-10\"><jats:title>Results<\/jats:title><jats:p>A total of 154 RCTs (32 762 participants) were included in the main analysis. Intravenous iron was associated with an increased risk of infection when compared with oral iron or no iron (RR, 1.16; 95% CI, 1.03-1.29; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200936%; moderate certainty of evidence). Intravenous iron also was associated with an increase in hemoglobin (mean difference, 0.57 g\/dL; 95% CI, 0.50-0.64 g\/dL; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200994%) and a reduction in the risk of requiring a red blood cell transfusion (RR, 0.83; 95% CI, 0.76-0.89; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200915%) when compared with oral iron or no iron. There was no evidence of an effect on mortality or hospital length of stay.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi210958-11\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this large systematic review and meta-analysis, intravenous iron was associated with an increased risk of infection. Well-designed studies, using standardized definitions of infection, are required to understand the balance between this risk and the potential benefits.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2021.33935","type":"journal-article","created":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T16:31:30Z","timestamp":1636734690000},"page":"e2133935","source":"Crossref","is-referenced-by-count":130,"title":["Risk of Infection Associated With Administration of Intravenous Iron"],"prefix":"10.1001","volume":"4","author":[{"given":"Akshay A.","family":"Shah","sequence":"first","affiliation":[{"name":"Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom"},{"name":"National Institute for Health Research Biomedical Research Centre Haematology Theme, Oxford, United Kingdom"},{"name":"Adult Intensive Care Unit, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Killian","family":"Donovan","sequence":"additional","affiliation":[{"name":"Adult Intensive Care Unit, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Seeley","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Royal Berkshire Hospitals NHS Foundation Trust, Reading, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward A.","family":"Dickson","sequence":"additional","affiliation":[{"name":"National Institute for Health Research Biomedical Research Centre in Gastrointestinal and Liver Diseases, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom."},{"name":"Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antony J. R.","family":"Palmer","sequence":"additional","affiliation":[{"name":"Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn","family":"Doree","sequence":"additional","affiliation":[{"name":"Systematic Review Initiative, NHS Blood & Transplant, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Brunskill","sequence":"additional","affiliation":[{"name":"Systematic Review Initiative, NHS Blood & Transplant, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Reid","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Austin 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