According to a study published in Neurology, community antibiotic use and infections requiring hospitalization had a strong temporal association with the risk of subsequent Guillain-Barré syndrome (GBS).
In a nationwide population-based case-control study carried out in Denmark, investigators identified all patients with first-time hospital-diagnosed GBS between 1987 and 2016 and matched 10 population controls per case. In total 2414 incident GBS cases were included along with 23,909 matched control participants.
Hospital-diagnosed infections were found in 4.3% of GBS cases and 0.3% of the control participants within a 60-day window prior to GBS. The odds ratio (OR) for developing GBS for patients with hospital-diagnosed infections compared with participants without infection in the 60-day window was 13.7 (95% CI, 10.2-18.5).
The strongest associations between specific infections and subsequent GBS were found for lower respiratory tract infection (OR, 14.7; 95% CI, 8.5-25.6), gastrointestinal tract infection (OR, 15.5; 95% CI, 7.0-34.1), and septicemia (OR, 17.9; 95% CI, 6.0-53.3).
In terms of community antibiotic prescriptions within 60 days of GBS, 22.4% of 1,086 GBS cases and 7.8% of 10,747 in the control participants were observed to have a prescription, resulting in a matched OR of 3.5 (95% CI, 3.0-4.1). The risk estimates of GBS for most types of prescriptions were similar to the overall estimate, but antiprotozoal and anthelminthic drugs did have a weaker association (OR, 1.8; 95% CI, 1.1-3.2).
The risk of GBS declined substantially as time since infection increased. The OR for hospital-diagnosed infections and community antibiotic prescriptions within the first month were 21.3 (95% CI, 14.5-31.2) and 4.7 (95% CI, 3.9-5.7), respectively.
The associations decreased within the second month prior to GBS (OR, 5.8; 95% CI, 3.4-9.8) for hospital-diagnosed infections and community antibiotic prescriptions (OR, 1.8; 95% CI, 1.4-2.3).
In the third month prior to GBS, the OR for hospital-diagnosed infection was 2.6 (95% CI, 1.3-5.1) and 1.6 (95% CI, 1.3-2.1) for community antibiotic prescriptions.
However, in the months after infection, GBS risk remained increased and in the fifth month postinfection, the risk had increased 2.4-fold (95% CI, 1.1-5.5) for hospital-diagnosed infections and 1.5-fold (95% CI, 1.2-2.0) for community antibiotic prescriptions.
Investigators reported some patients were incorrectly registered with GBS, potentially leading to underestimations of infection associations and a false correlation between sepsis and GBS.
According to investigators, this work provides robust evidence for the strong associations between both hospital-diagnosed infections and community antibiotic prescriptions with subsequent GBS risk. They also pointed out that results indicated that severity of infection is an important risk factor.
Future population-based studies with access to microbiological data might provide a clearer understanding of the mechanisms behind the induction of GBS by specific infections, said investigators.
Levison LS, Thomsen RW, Sindrup SH, Andersen H. Association of hospital-diagnosed infections and antibiotic use with risk of developing Guillain-Barré syndrome. Neurology. 2021;96(6):e831-e839. doi:10.1212/WNL.0000000000011342