TY - JOUR
T1 - Association of Hospital-Diagnosed Infections and Antibiotic Use with Risk of Developing Guillain-Barré Syndrome
AU - Levison, Lotte
AU - Thomsen, RW
AU - Sindrup, Søren Hein
AU - Andersen, Henning
PY - 2021/2/9
Y1 - 2021/2/9
N2 - ObjectiveTo 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.MethodsWe 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 1987-2016 period and community antibiotic prescriptions in the 2004-2016 period. We used conditional logistic regression to examine the relative risk of GBS associated with having a recent infection.ResultsHospital-diagnosed infections within 60 days were observed in 4.3% of 2,414 GBS cases vs 0.3% of 23,909 controls, with a matched odds ratio (OR) of 13.7 (95% confidence interval [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.ConclusionThere is a strong, temporal association between community antibiotic use and especially infections necessitating hospitalization and risk of subsequent GBS.
AB - ObjectiveTo 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.MethodsWe 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 1987-2016 period and community antibiotic prescriptions in the 2004-2016 period. We used conditional logistic regression to examine the relative risk of GBS associated with having a recent infection.ResultsHospital-diagnosed infections within 60 days were observed in 4.3% of 2,414 GBS cases vs 0.3% of 23,909 controls, with a matched odds ratio (OR) of 13.7 (95% confidence interval [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.ConclusionThere is a strong, temporal association between community antibiotic use and especially infections necessitating hospitalization and risk of subsequent GBS.
KW - Guillain-Barre Syndrome/epidemiology
UR - http://www.scopus.com/inward/record.url?scp=85102090540&partnerID=8YFLogxK
U2 - 10.1212/WNL.0000000000011342
DO - 10.1212/WNL.0000000000011342
M3 - Journal article
C2 - 33318166
SN - 0028-3878
VL - 96
SP - E831-E839
JO - Neurology
JF - Neurology
IS - 6
ER -