Role of Iron, Zinc, and Copper Homeostasis in Patients with Multidrug-Resistant Bacterial Infections

Lubna Khalid Farhan

Authors

Lubna Khalid Farhan University of Fallujah - College of applied science, Department of applied Chemistry, Iraq - Al_ anbar

Keywords:

Multidrug-resistant bacterial infections, Nutritional immunity, Iron metabolism, Trace element homeostasis, Inflammatory biomarkers

Abstract

Background: Disruption of iron, zinc, and copper homeostasis may contribute to immune dysfunction, inflammation, and disease severity in multidrug-resistant bacterial infections. Aims of the study: This study aimed to evaluate iron, zinc, and copper homeostasis in multidrug-resistant bacterial infections and determine their associations with inflammatory biomarkers, hematological parameters, and clinical risk factors. Methodology: A case–control study was conducted at Al-Habbobi Teaching Hospital, Thi-Qar, Iraq, between June 2025 and March 2026, including 60 patients with multidrug-resistant (MDR) bacterial infections, 60 with non-MDR infections, and 30 healthy controls. MDR isolates were identified according to CLSI guidelines. Serum iron, ferritin, transferrin, TIBC, zinc, copper, CRP, IL-6, TNF-α, and hematological parameters were measured using standard laboratory methods. Statistical analyses included ANOVA, Pearson correlation, and multivariate logistic regression, with P < 0.05 considered statistically significant. Result: Patients with MDR bacterial infections showed significantly higher BMI, inflammatory markers, WBC counts, and prevalence of diabetes, prior antibiotic use, and hospitalization than other groups. Escherichia coli was the predominant isolate. MDR infections exhibited marked reductions in serum iron, transferrin, TIBC, and zinc, with increased ferritin, copper, and Cu/Zn ratio (all P<0.001). Trace element alterations correlated significantly with inflammatory biomarkers. Previous antibiotic use, elevated Cu/Zn ratio, ferritin, CRP, low zinc, hospitalization, and diabetes independently predicted MDR bacterial infections. Conclusions: Disturbances in iron, zinc, and copper homeostasis are strongly associated with multidrug-resistant bacterial infections and parallel systemic inflammation. The Cu/Zn ratio, ferritin, and zinc may serve as valuable complementary biomarkers for assessing infection severity and identifying patients at increased risk of MDR infections.

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