Healthcare-Associated Mycobacterium bovis-Bacille Calmette-Guerin (BCG) Infection in Cancer Patients Without Prior BCG Instillation
Por:
Meije, Y, Martinez-Montauti, J, Cayla, JA, Loureiro, J, Ortega, L, Clemente, M, Sanz, X, Ricart, M, Santoma, MJ, Coll, P, Sierra, M, Calsina, M, Vaque, M, Ruiz-Camps, I, Lopez-Sanchez, C, Montes, M, Ayestaran, A, Carratala, J, Orcau, A
Publicada:
1 oct 2017
Resumen:
Background. Bacille Calmette-Guerin (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.
Filiaciones:
Meije, Y:
Hosp Barcelona, SCIAS, Infect Dis Unit, Dept Internal Med, Barcelona, Spain
Hosp Barcelona, SCIAS, Joint Commiss Infect Dis Management Control & Pre, Barcelona, Spain
Martinez-Montauti, J:
Hosp Barcelona, SCIAS, Infect Dis Unit, Dept Internal Med, Barcelona, Spain
Hosp Barcelona, SCIAS, Joint Commiss Infect Dis Management Control & Pre, Barcelona, Spain
Cayla, JA:
Publ Hlth Agcy Barcelona, Epidemiol Serv, Barcelona, Spain
CIBER Epidemiol & Salud Publ, Barcelona, Spain
Loureiro, J:
Hosp Barcelona, SCIAS, Infect Dis Unit, Dept Internal Med, Barcelona, Spain
Ortega, L:
Hosp Barcelona, SCIAS, Infect Dis Unit, Dept Internal Med, Barcelona, Spain
Clemente, M:
Hosp Barcelona, SCIAS, Infect Dis Unit, Dept Internal Med, Barcelona, Spain
Hosp Barcelona, SCIAS, Joint Commiss Infect Dis Management Control & Pre, Barcelona, Spain
Sanz, X:
Hosp Barcelona, SCIAS, Infect Dis Unit, Dept Internal Med, Barcelona, Spain
Ricart, M:
Publ Hlth Agcy Barcelona, Epidemiol Serv, Barcelona, Spain
CIBER Epidemiol & Salud Publ, Barcelona, Spain
Santoma, MJ:
Publ Hlth Agcy Barcelona, Epidemiol Serv, Barcelona, Spain
CIBER Epidemiol & Salud Publ, Barcelona, Spain
Coll, P:
Hosp Santa Creu & Sant Pau, Fundacio Gestio Sanitaria, Microbiol Dept, Barcelona, Spain
Univ Autonoma Barcelona, Dept Genet & Microbiol, Barcelona, Spain
Inst Invest Biomed St Pau, Barcelona, Spain
Spanish Network Res Infect Dis, Madrid, Spain
Sierra, M:
Hosp Barcelona, SCIAS, Microbiol Dept, Barcelona, Spain
Calsina, M:
Hosp Barcelona, SCIAS, Joint Commiss Infect Dis Management Control & Pre, Barcelona, Spain
Vaque, M:
Hosp Barcelona, SCIAS, Joint Commiss Infect Dis Management Control & Pre, Barcelona, Spain
Ruiz-Camps, I:
Hosp Univ Vall DHebron, Infect Dis Dept, Barcelona, Spain
Lopez-Sanchez, C:
Hosp Univ Vall DHebron, Infect Dis Dept, Barcelona, Spain
Montes, M:
Hosp Barcelona, SCIAS, Pharm Dept, Barcelona, Spain
Ayestaran, A:
Hosp Barcelona, SCIAS, Joint Commiss Infect Dis Management Control & Pre, Barcelona, Spain
Hosp Barcelona, SCIAS, Pharm Dept, Barcelona, Spain
Carratala, J:
Spanish Network Res Infect Dis, Madrid, Spain
Hosp Univ Bellvitge, IDIBELL, Dept Infect Dis, Barcelona, Spain
Univ Barcelona, Dept Clin Sci, Barcelona, Spain
Orcau, A:
Publ Hlth Agcy Barcelona, Epidemiol Serv, Barcelona, Spain
CIBER Epidemiol & Salud Publ, Barcelona, Spain
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