Malhotra Prashant, Farber Bruce F
Division of Infectious Diseases, Hofstra North Shore-LIJ School of Medicine at Hofstra University, Manhasset, New York, USA.
Can J Urol. 2011 Jun;18(3):5671-5.
Bacillus Calmette Guerin (BCG) immunotherapy is widely used for treatment of superficial bladder transitional cell carcinoma. Infectious complications while rare can be serious and severe disseminated infections as well as sepsis has been reported. There are no standard guidelines to direct therapy of these complications. Isoniazid is a commonly and widely used component of the various treatment regimens. Various strains of BCG are used for treatment of bladder cancer as well as vaccinations. These strains have evolved because of repeated subcultures in various laboratories in the world and have been shown to exhibit phenotypic differences in their immunogenicity as well as recently in susceptibility to various antimycobacterial agents. In this article, we review the resistance of BCG strains to various antimycobacterial agents. Some of these strains including the BCG Connaught strain, which is widely used in the United States, Canada and some other parts of the world for bladder cancer therapy exhibit intrinsic resistance to isoniazid. Although the clinical relevance of these differences is unclear, recent studies have questioned the role of isoniazid in treatment of infections after vaccination with these strains. Also, use of isoniazid in combination therapy for these infections may lead to the development of resistance to other antimycobacterial agents. We conclude that isoniazid may not be a suitable agent for empiric treatment of infections related to intravesical immunotherapy for bladder cancer with these strains and further studies are needed to clarify its role.
卡介苗（BCG）免疫疗法广泛用于浅表性膀胱移行细胞癌的治疗。感染并发症虽罕见，但可能很严重，已有严重播散性感染及败血症的报道。目前尚无指导这些并发症治疗的标准指南。异烟肼是各种治疗方案中常用且广泛使用的成分。多种卡介苗菌株用于膀胱癌治疗及疫苗接种。由于在世界各地不同实验室反复传代培养，这些菌株发生了进化，已显示出其免疫原性以及最近对各种抗分枝杆菌药物的敏感性存在表型差异。在本文中，我们综述了卡介苗菌株对各种抗分枝杆菌药物的耐药性。其中一些菌株，包括在美國、加拿大和世界其他一些地区广泛用于膀胱癌治疗的康诺特卡介苗菌株，对异烟肼表现出固有耐药性。尽管这些差异的临床相关性尚不清楚，但最近的研究对异烟肼在这些菌株接种后感染治疗中的作用提出了质疑。此外，在这些感染的联合治疗中使用异烟肼可能会导致对其他抗分枝杆菌药物产生耐药性。我们得出结论，异烟肼可能不是用这些菌株进行膀胱癌膀胱内免疫治疗相关感染经验性治疗的合适药物，需要进一步研究以阐明其作用。
