Yolanda Meije1,2, Joaquín Martínez-Montauti1,2, Joan A Caylà3, Jose Loureiro1, Lucía Ortega1, Mercedes Clemente1,2, Xavier Sanz1, Montserrat Ricart3, María J Santomà3, Pere Coll4,5,6,7, Montserrat Sierra2,8, Marta Calsina2, Montserrat Vaqué2, Isabel Ruiz-Camps9, Cristina López-Sánchez9, Mar Montes10, Ana Ayestarán2,10, Jordi Carratalà7,11,12, Àngels Orcau3. 1. Infectious Disease Unit, Internal Medicine Department, and. 2. Joint Commission for the Infectious Disease Management, Control and Prevention, Hospital de Barcelona, Societat Cooperativa d'Installacions Assistencials Sanitàries (SCIAS). 3. Epidemiology Service. Public Health Agency of Barcelona and CIBER de Epidemiologia y Salud Pública. 4. Microbiology Department, Fundació de Gestió Sanitaria del Hospital de la Santa Creu i Sant Pau. 5. Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, and. 6. Institut d'Investigació Biomèdica Sant Pau, Barcelona. 7. Spanish Network for the Research in Infectious Diseases, Madrid. 8. Microbiology Department, Hospital de Barcelona, SCIAS. 9. Infectious Diseases Department, Hospital Universitari Vall d'Hebron. 10. Pharmacy Department, Hospital de Barcelona, SCIAS. 11. Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, and. 12. Department of Clinical Sciences, University of Barcelona, Spain.
Abstract
Background: Bacille Calmette-Guérin (BCG), an attenuated strain of Mycobacterium bovis, is widely used as adjunctive therapy for superficial bladder cancer. Intravesical administration of BCG has been associated with systemic infection. Disseminated infection due to M. bovis is otherwise uncommon. Methods: After identification of 3 patients with healthcare-associated BCG infection who had never received intravesical BCG administration, an epidemiologic study was performed. All patients with healthcare-associated BCG infection in the Barcelona tuberculosis (TB) program were reviewed from 1 January 2005 to 31 December 2015, searching for infections caused by M. bovis-BCG. Patients with healthcare-associated BCG infection who had not received intravesical BCG instillation were selected and the source of infection was investigated. Results: Nine oncology patients with infection caused by M. bovis-BCG were studied. All had permanent central venous catheters. Catheter maintenance was performed at 4 different outpatient clinics in the same room in which other patients underwent BCG instillations for bladder cancer without required biological precautions. All patients developed pulmonary TB, either alone or with extrapulmonary disease. Catheter-related infection was considered the mechanism of acquisition based on the epidemiologic association and positive catheter cultures for BCG in patients in whom mycobacterial cultures were performed. Conclusions: Physicians should be alerted to the possibility of TB due to nosocomially acquired, catheter-related infections with M. bovis-BCG in patients with indwelling catheters. This problem may be more common than expected in centers providing BCG therapy for bladder cancer without adequate precautions.
Background: Bacille Calmette-Guérin (BCG), an attenuated strain of Mycobacterium bovis, is widely used as adjunctive therapy for superficial bladder cancer. Intravesical administration of BCG has been associated with systemic infection. Disseminated infection due to M. bovis is otherwise uncommon. Methods: After identification of 3 patients with healthcare-associated BCG infection who had never received intravesical BCG administration, an epidemiologic study was performed. All patients with healthcare-associated BCG infection in the Barcelona tuberculosis (TB) program were reviewed from 1 January 2005 to 31 December 2015, searching for infections caused by M. bovis-BCG. Patients with healthcare-associated BCG infection who had not received intravesical BCG instillation were selected and the source of infection was investigated. Results: Nine oncology patients with infection caused by M. bovis-BCG were studied. All had permanent central venous catheters. Catheter maintenance was performed at 4 different outpatient clinics in the same room in which other patients underwent BCG instillations for bladder cancer without required biological precautions. All patients developed pulmonary TB, either alone or with extrapulmonary disease. Catheter-related infection was considered the mechanism of acquisition based on the epidemiologic association and positive catheter cultures for BCG in patients in whom mycobacterial cultures were performed. Conclusions: Physicians should be alerted to the possibility of TB due to nosocomially acquired, catheter-related infections with M. bovis-BCG in patients with indwelling catheters. This problem may be more common than expected in centers providing BCG therapy for bladder cancer without adequate precautions.
Authors: Zimy Wansaula; Jonathan M Wortham; Godwin Mindra; Maryam B Haddad; Jorge L Salinas; David Ashkin; Sapna B Morris; Gail B Grant; Smita Ghosh; Adam J Langer Journal: Emerg Infect Dis Date: 2019-03 Impact factor: 6.883