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

Abstract

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.