NEW ORLEANSBeware the juxtaposition of BCG (Bacillus Calmette and
Guérin) and other chemotherapeutic agents. Four patients in
the same oncology outpatient clinic in Barcelona, Spain, developed
disseminated BCG infection around the same time, apparently due to
BCG-contaminated intravenous catheters, Dr. Javier Garau reported at
the 36th Interscience Conference on Antimicrobial Agents and
All four patients had an implanted IV catheter with a subcutaneous
reservoir (Port-a-cath). All developed constitutional symptoms and
miliary tuberculosis pattern on chest x-ray, and were
culture-positive for Mycobacterium bovus, said Dr. Garau, of the
Hospital Mutua de Terrassa and Majadahonda National Center. Three
patients presented with symptoms 9 months after presumed exposure,
and one became ill at 12 months. Treatment was effective.
The infections were traced to a common setting in which intravesical
BCG instillation and IV catheter heparin-ization were carried out.
Records review showed that the four infected patients received
chemotherapy on the same days that BCG was prepared for instillation
in bladder cancer patients.
The patients' IV catheters and reservoirs were found to contain
Mycobacterium bovis. The three different isolates from the patients
and the strain from the lot of BCG used during this period were identical.
"We never did figure out where any hygienic measures were
violated," Dr. Garau said. "There is the potential for
these live agents to be aerosolized and therefore mixed up with other
chemotherapeutic agents," he speculated.
The BCG instillation was changed to another area of the clinic, and
no new cases of tuberculosis have occurred in oncology outpatients,