Infectious Disease Unit, Internal Medicine Department, and.
Joint Commission for the Infectious Disease Management, Control and Prevention, Hospital de Barcelona, Societat Cooperativa d'Installacions Assistencials Sanitàries (SCIAS).
Clin Infect Dis. 2017 Oct 1;65(7):1136-1143. doi: 10.1093/cid/cix496.
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.
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.
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.
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.
卡介苗（BCG）是牛分枝杆菌的减毒菌株，广泛用于辅助治疗浅表膀胱癌。BCG 的膀胱内给药与全身感染有关。由于牛分枝杆菌引起的播散性感染并不常见。
在发现 3 例从未接受过膀胱内 BCG 给药的与医疗保健相关的 BCG 感染患者后，进行了一项流行病学研究。对 2005 年 1 月 1 日至 2015 年 12 月 31 日期间巴塞罗那结核病（TB）计划中所有与医疗保健相关的 BCG 感染患者进行了回顾性研究，寻找由牛分枝杆菌-BCG 引起的感染。选择未接受膀胱内 BCG 灌注的与医疗保健相关的 BCG 感染患者，并调查感染源。
研究了 9 例由牛分枝杆菌-BCG 引起的感染的肿瘤患者。所有患者均有永久性中心静脉导管。导管维护在同一房间的 4 个不同的门诊诊所进行，其他患者在该房间中接受膀胱癌的 BCG 灌注，而没有进行必要的生物预防措施。所有患者均发生肺结核，无论是单独发生还是合并肺外疾病。基于流行病学关联以及对进行分枝杆菌培养的患者的导管阳性 BCG 培养，将导管相关感染视为获得感染的机制。
对于留置导管的患者，应警惕因医院获得性、导管相关感染而导致的由牛分枝杆菌引起的 TB 的可能性。在未采取充分预防措施而提供膀胱癌 BCG 治疗的中心，此问题可能比预期更为常见。
