Bacillus Calmette-Guerin infection following intravesical instillation: Does the strain matter?

Med Mal Infect. 2019 Aug;49(5):350-355. doi: 10.1016/j.medmal.2018.11.014. Epub 2018 Dec 21.

Abstract

Purpose: Intravesical BCG is the standard treatment of non-muscle invasive bladder cancer. No difference has yet been reported in the safety profiles of the various BCG strains.

Methods: A nationwide multidisciplinary retrospective survey was conducted between January 2013 and December 2016 to identify cases of BCG infection and differentiate them based on the type of BCG strain used.

Results: Forty patients were identified (BCG RIVM 28; other strains 8; unknown 4). Patients treated with BCG RIVM were less severely ill, with fewer occurrences of septic shock (3.6% vs. 50%, P=0.003) and ICU admission (7.1% vs. 62.5%, P=0.003). A higher frequency of pulmonary miliaries (71.4% vs. 12.5%, P=0.005) but lower transaminase levels (mean AST 65 vs. 264 U/L, P=0.001) were observed in these patients. No difference in terms of recovery was reported.

Conclusion: The type of BCG strain could correlate with the frequency and severity of subsequent BCG infections.

Keywords: BCG; Cancer de vessie; Urothelial carcinoma.

Publication types

  • Multicenter Study

MeSH terms

  • Administration, Intravesical
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / adverse effects
  • BCG Vaccine / administration & dosage*
  • BCG Vaccine / adverse effects*
  • BCG Vaccine / classification
  • Bacillaceae Infections / etiology*
  • Bacillaceae Infections / microbiology
  • Carcinoma, Transitional Cell / drug therapy*
  • Carcinoma, Transitional Cell / pathology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Urinary Bladder Neoplasms / drug therapy*
  • Urinary Bladder Neoplasms / pathology
  • Urothelium / microbiology
  • Urothelium / pathology

Substances

  • Antineoplastic Agents
  • BCG Vaccine