Earlier infections and antibiotics associated to Guillain-Barré syndrome

According to a study published in Neurology, community use of antibiotics and infections that require hospitalization had a strong temporal association with the risk of subsequent Guillain-Barré syndrome (GBS).

In a nationwide population-based case-control study conducted in Denmark, the researchers identified all patients with first-time hospital-diagnosed GBS between 1987 and 2016 and compared 10 population controls per case. A total of 2,414 GBS incidents and 23,909 matching control participants were included.

Hospital-diagnosed infections were found in 4.3% of GBS cases and 0.3% of controls within a 60-day window before GBS. The odds ratio (OR) for the development of GBS in patients with infections diagnosed in hospital compared to 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 infections (OR, 14.7; 95% CI, 8.5-25.6), gastrointestinal infections (OR, 15.5; 95%) % CI, 7.0-34.1) and septicemia (OR 17.9; 95% CI 6.0-53.3).

Regarding community prescribing of antibiotics within 60 days of GBS, 22.4% of 1,086 GBS cases and 7.8% of 10,747 controls were observed to prescribe, resulting in a consistent OR of 3.5 led (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 anthelmintic drugs had a weaker association (OR, 1.8; 95% CI, 1.1-3.2).

The risk of GBS decreased significantly with time since infection. The OP for infections diagnosed in the hospital and the prescription of antibiotics in the ward within the first month were 21.3 (95% CI, 14.5-31.2) and 4.7 (95% CI, 3.9- 5.7).

Associations decreased within the second month before GBS (OR, 5.8; 95% CI, 3.4-9.8) for hospital-diagnosed infections and prescriptions of antibiotics in the community (OR, 1.8; 95% CI, 1.4-2.3).

In the third month prior to GBS, OP for a hospital diagnosed infection was 2.6 (95% CI, 1.3-5.1) and 1.6 (95% CI, 1.3-2.1) for the prescription of antibiotics in the community.

However, in the months after infection, the risk of GBS remained increased, and by the fifth month after infection, the risk of hospital-diagnosed infections had increased 2.4-fold (95% CI, 1.1-5.5) and increased by 1.5 times (95% CI, 1.2) -2.0) for antibiotic prescriptions in the community.

The researchers reported that some patients were mistakenly registered for GBS, possibly leading to an underestimation of the infection associations and a false correlation between sepsis and GBS.

According to the researchers, this work provides robust evidence of the strong links between infections diagnosed in the hospital and community-prescribed antibiotics with subsequent GBS risk. They also indicated that the results indicated that the severity of the infection is a major risk factor.

Future population-based studies with access to microbiological data could provide a clearer understanding of the mechanisms behind the induction of GBS by specific infections, the researchers said.


Levison LS, Thomsen RW, Sindrup SH, Andersen H. Association of infections diagnosed in hospital and the use of antibiotics with the risk of developing Guillain-Barré syndrome. Neurology. 2021; 96 (6): e831-e839. doi: 10.1212 / WNL.0000000000011342

This article originally appeared on Infectious Disease Advisor

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