Association of Hospital-Diagnosed Infections and Antibiotic Use with Risk of Developing Guillain-Barré Syndrome

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Objective: To determine whether hospital-diagnosed and community-treated infections are important Guillain-Barré syndrome (GBS) risk factors, we investigated the magnitude and duration of associated GBS risk.

Methods: We conducted a nationwide population-based case-control study of all patients with first-time hospital-diagnosed GBS in Denmark between 1987 and 2016 and 10 matched population controls per case. Hospital-diagnosed infections were determined in the period 1987 to 2016, and community antibiotic prescriptions in the period 2004 to 2016. We used conditional logistic regression to examine the relative risk of GBS associated with having a recent infection.

Results: Hospital-diagnosed infections within 60 days were observed in 4.3% of 2,414 GBS cases versus 0.3% of 23,909 controls, with a matched odds ratio (OR) of 13.7 (95% CI, 10.2-18.5). The strongest association with subsequent GBS was observed for lower respiratory tract infection, gastrointestinal tract infection, and septicemia. Community antibiotic prescriptions within 60 days were observed in 22.4% of 1,086 GBS cases and 7.8% of 10,747 controls, with a matched OR of 3.5 (95% CI, 3.0-4.1). The risk of GBS declined considerably with time since infection, with high ORs of 21.3 (95% CI, 14.5-31.2) and 4.7 (95% CI, 3.9-5.7) observed within the first month after a hospital-diagnosed infection and a community antibiotic prescription, respectively. However, GBS risk remained increased 2.4-fold (95% CI, 1.1-5.5) and 1.5-fold (95% CI, 1.2-2.0) even in the fifth month after infection.

Conclusion: There is a strong, temporal association between community antibiotic use and especially infections necessitating hospitalization and risk of subsequent GBS.
StatusUdgivet - feb. 2021


  • Guillain-Barre Syndrome/epidemiology

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