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 Chemotherapy (ICAAC).
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(Drug information on 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, he said.