TY - JOUR
T1 - Healthcare-Associated Mycobacterium bovis -Bacille Calmette-Guérin (BCG) Infection in Cancer Patients Without Prior BCG Instillation
AU - Meije, Yolanda
AU - Martínez-Montauti, Joaquín
AU - Caylà, Joan A.
AU - Loureiro, Jose
AU - Ortega, Lucía
AU - Clemente, Mercedes
AU - Sanz, Xavier
AU - Ricart, Montserrat
AU - Santomà, María J.
AU - Coll, Pere
AU - Sierra, Montserrat
AU - Calsina, Marta
AU - Vaqué, Montserrat
AU - Ruiz-Camps, Isabel
AU - López-Sánchez, Cristina
AU - Montes, Mar
AU - Ayestarán, Ana
AU - Carratalà, Jordi
AU - Orcau, Àngels
N1 - Funding Information:
1Infectious Disease Unit, Internal Medicine Department, and 2Joint Commission for the Infectious Disease Management, Control and Prevention, Hospital de Barcelona, Societat Cooperativa d’Installacions Assistencials Sanitàries (SCIAS), 3Epidemiology Service. Public Health Agency of Barcelona and CIBER de Epidemiologia y Salud Pública, 4Microbiology Department, Fundació de Gestió Sanitaria del Hospital de la Santa Creu i Sant Pau, 5Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, and 6Institut d’Investigació Biomèdica Sant Pau, Barcelona, 7Spanish Network for the Research in Infectious Diseases, Madrid, 8Microbiology Department, Hospital de Barcelona, SCIAS, 9Infectious Diseases Department, Hospital Universitari Vall d´Hebron, 10Pharmacy Department, Hospital de Barcelona, SCIAS, 11Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, and 12Department of Clinical Sciences, University of Barcelona, Spain
Publisher Copyright:
© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
PY - 2017/10/1
Y1 - 2017/10/1
N2 - 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.
AB - 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.
KW - Mycobacterium bovis -BCG
KW - catheter-related infection
KW - healthcare infection
KW - nosocomial infection
KW - outbreak
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U2 - 10.1093/cid/cix496
DO - 10.1093/cid/cix496
M3 - Article
C2 - 28575173
AN - SCOPUS:85030683951
SN - 1058-4838
VL - 65
SP - 1136
EP - 1143
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 7
ER -