title: Individuals hospitalized with acute mania have increased exposure to antimicrobial medications.
abstract: We have preciously documented that many individuals with acute mania have immune activation. However, the sources of immune activation have not been identified. We investigated whether individuals hospitalized with acute mania have evidence of bacterial infections as determined by the prescription of systemic antimicrobial agents.
  
  
  
  We assessed the recent prescription of systemic antimicrobial medications and the site of presumed bacterial infection in 234 individuals hospitalized for acute mania in either an inpatient unit or a day hospital. We also assessed individuals hospitalized for other psychiatric disorders (n=368) and controls (n=555). We employed logistic regression models to compare the rates of antibiotic prescription in individuals with the different diagnoses, employing demographic variables as covariates.
  
  
  
  We found that individuals hospitalized with acute mania had a substantially increased rate of recent antimicrobial prescription, defined as exposure within three days of ascertainment (adjusted odds ratio=5.5, 95% confidence interval: 2.2-14.1, P<.0002). Overall, a total of 18 of the 234 (7.7%) individuals hospitalized for acute mania were prescribed antibiotics as opposed to seven of 555 (1.3%) controls. The prescription of antibiotics was associated with being on an inpatient unit as opposed to being in the day hospital, and having increased mania symptom severity but not with other clinical ratings, demographic variables, or psychiatric medications. Hospitalization for other psychiatric disorders was not associated with the recent prescription of antimicrobial medications. The urinary tract was the most common site of infection in women, while the respiratory tract and mucosal surfaces were the most common sites in men.
  
  
  
  Individuals hospitalized with acute mania have a markedly increased rate of bacterial infections, as evidenced by the recent prescription of antimicrobial agents. The prevention and effective treatment of bacterial infections may be important interventions for the management of individuals with mania.
authors.affiliation: Stanley Neurovirology Laboratory, Johns Hopkins School of Medicine, Baltimore, MD,, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Yolken
authors.affiliation: Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Adamos
authors.affiliation: Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Katsafanas
authors.affiliation: Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Khushalani
authors.affiliation: Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Origoni
authors.affiliation: Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Savage
authors.affiliation: Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA.
authors.forename: Lucy
authors.initials: L
authors.lastname: Schweinfurth
authors.affiliation: Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA.
authors.forename: Cassie
authors.initials: C
authors.lastname: Stallings
authors.affiliation: Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Sweeney
authors.affiliation: Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA.
authors.forename: Faith
authors.initials: F
authors.lastname: Dickerson
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D001714:Bipolar Disorder / Q000175:diagnosis / Q000209:etiology / Q000276:immunology / Q000628:therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D055553:Prescription Drugs / Q000627:therapeutic use; D011569:Psychiatric Status Rating Scales; D013223:Statistics as Topic; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D055553:Prescription Drugs
keywords: antibiotic; infection; inflammation; mania