medigraphic.com
Organo Oficial de la Sociedad Mexicana de Urología

2025, Number 4

<< Back

Rev Mex Urol 2025; 85 (4)

Intravesical bacillus Calmette-Guérin (BCG) instillation: are we doing things right in Latin America?

González CC, Medel R, García BL, Arbizu M, Gramajo FM, Sánchez NB, Vargas CC, Palma SL, De Bonis W, Barreiro D, Graziano C

Language: English
References: 17
Page: 1-10
PDF size: 249.76 Kb.


ABSTRACT

Introduction and objectives: seventy five percent of bladder cancer is non muscle invasive (NMIBC) for which intravesical instillation with BCG has been the cornerstone of treatment. BCG has been categorized as dangerous; this is why there are international guidelines that describe its use. The objective of this paper is to investigate the adherence of Latin American health workers with guidelines for the safe intravesical application of BCG for NMIBC.
Materials and methods: we conducted an anonymous and self-administered survey during 2 months of 2023 on a digital platform among health workers. It consisted of 19 questions focusing on compliance with standards set by international organizations and its correct use. Descriptive statistics were carried out; p‹0.05 was considered statistically significant. Correct and safe use of BCG was evaluated through 4 questions.
Results: a total of 295 completed surveys were recorded from 12 countries. A total of 96.61 % (n= 285) performed BCG instillation incorrectly. Prior training was received by 55 % of which 97.5 % administered it incorrectly against 95.48 % who did so without prior training (p=0.33). Before answering this questionnaire, 90.51 % considered their technique adequate against 83.83 % after answering it, observing a change in the perception of participants (p= 0.0139).
Conclusion: there is almost no adherence of health professionals with protocols, so it is crucial to improve training based on international guidelines to minimize the risk of BCG contamination.


REFERENCES

  1. Global Burden of Disease CancerCollaboration, Fitzmaurice C, Allen C, BarberRM, Barregard L, Bhutta ZA, et al. Global,Regional, and National Cancer Incidence,Mortality, Years of Life Lost, Years Lived WithDisability, and Disability-Adjusted Life-years for32 Cancer Groups, 1990 to 2015: A SystematicAnalysis for the Global Burden of Disease Study.JAMA oncology. 2017;3(4): 524–548. https://doi.org/10.1001/jamaoncol.2016.5688.

  2. Burger M, Catto JWF, Dalbagni G, GrossmanHB, Herr H, Karakiewicz P, et al. Epidemiologyand risk factors of urothelial bladder cancer.European Urology. 2013;63(2): 234–241.https://doi.org/10.1016/j.eururo.2012.07.033.

  3. Babjuk M, Burger M, Capoun O, Cohen D,Compérat EM, Dominguez Escrig JL, et al.European Association of Urology Guidelineson Non-muscle-invasive Bladder Cancer (Ta,T1, and Carcinoma in Situ). European Urology.2022;81(1): 75–94. https://doi.org/10.1016/j.eururo.2021.08.010.

  4. Lamm DL, Blumenstein BA, CrissmanJD, Montie JE, Gottesman JE, Lowe BA, etal. Maintenance bacillus Calmette-Guerinimmunotherapy for recurrent TA, T1 andcarcinoma in situ transitional cell carcinomaof the bladder: a randomized SouthwestOncology Group Study. The Journal of Urology.2000;163(4): 1124–1129.

  5. Gomella LG. Is BCG a Hazardous Drug? AskNIOSH, OSHA, and the USP. The CanadianJournal of Urology. 2019;26(2): 9687–9689.

  6. Lange C, Aaby P, Behr MA, Donald PR,Kaufmann SHE, Netea MG, et al. 100 years ofMycobacterium bovis bacille Calmette-Guérin.The Lancet. Infectious Diseases. 2022;22(1): e2–e12. https://doi.org/10.1016/S1473-3099(21)00403-5.

  7. Mignard S, Pichat C, Carret G. Mycobacteriumbovis Infection, Lyon, France. EmergingInfectious Diseases. 2006;12(9): 1431–1433.https://doi.org/10.3201/eid1209.060209.

  8. Leon P, Saint F, Audenet F, Roumiguié M,Allory Y, Loriot Y, et al. Recommandationsdu Comité de cancérologie de l’AssociationFrançaise d’Urologie (CC-AFU) pour labonne pratique des instillations intravésicalesde mitomycine C, d’épirubicine et de BCGpour le traitement des tumeurs de la vessien’infiltrant pas le muscle (TVNIM). Progrèsen Urologie. 2022;32(5): 299–311. https://doi.org/10.1016/j.purol.2022.01.004.

  9. Lauridsen SV, De Blok W, Retinger NL,Jensen BT, Turner B, Villa G, et al. Intravesicalinstillation with mitomycin C or bacillus Calmette-Guérin in non-muscle invasive bladder cancer.European Association of Urology Nursing; 2015.https://pure.au.dk/portal/en/publications/intravesical-instillation-with-mitomycin-c-orbacillus-calmette-g [Accessed 4th July 2025].

  10. Villoldo GM, Gonzalez MI, Faune AV,Molina RC, Montoya LFM, Salcedo JGC, etal. Multicenter Retrospective Registry Studyon BCG Use in Non-Muscle Invasive BladderCancer in Latin America: BLATAM (BladderCancer in Latin America) Group. Internationalbraz j urol. 2025;51(3): e20240615. https://doi.org/10.1590/s1677-5538.ibju.2024.0615.

  11. Piñeros M, Laversanne M, Barrios E, CancelaM de C, Vries E de, Pardo C, et al. An updatedprofile of the cancer burden, patterns and trendsin Latin America and the Caribbean. The Lancet Regional Health – Americas. 2022;13. https://doi.org/10.1016/j.lana.2022.100294.

  12. Vigler M, Mulett H, Hausman MR. ChronicMycobacterium infection of first dorsal webspace after accidental Bacilli Calmette-Guérininjection in a health worker: case report. TheJournal of Hand Surgery. 2008;33(9): 1621–1624.https://doi.org/10.1016/j.jhsa.2008.05.019.

  13. Waecker NJ, Stefanova R, Cave MD, Davis CE,Dankner WM. Nosocomial transmission ofMycobacterium bovis bacille Calmette-Guerinto children receiving cancer therapy and totheir health care providers. Clinical InfectiousDiseases: An Official Publication of the InfectiousDiseases Society of America. 2000;30(2): 356–362. https://doi.org/10.1086/313652.

  14. Vos MC, de Haas PEW, Verbrugh HA, RendersNHM, Hartwig NG, de Man P, et al. NosocomialMycobacterium bovis-bacille Calmette-Guérin infections due to contamination ofchemotherapeutics: case finding and routeof transmission. The Journal of InfectiousDiseases. 2003;188(9): 1332–1335. https://doi.org/10.1086/379034.

  15. Meije Y, Martínez-Montauti J, Caylà JA,Loureiro J, Ortega L, Clemente M, et al.Healthcare-Associated Mycobacterium bovis–Bacille Calmette-Guérin (BCG) Infection inCancer Patients Without Prior BCG Instillation.Clinical Infectious Diseases. 2017;65(7): 1136–1143.

  16. Aqua JK, Holdsworth J, Burd E, Jacob JT,Ray SM, Schechter MC. Mycobacterium bovisBacillus Calmette-Guérin Cross-Contaminationin the Operating Room: A Case Report. Journalof Investigative Medicine High Impact CaseReports. 2021;9: 23247096211066287. https://doi.org/10.1177/23247096211066287.

  17. Adams EJ, Amerine LB. Process improvementstrategy to prepare and administer bacillusCalmette-Guérin vaccine in compliancewith United States Pharmacopeia chapter800 standards. American journal of healthsystempharmacy: AJHP: official journal of theAmerican Society of Health-System Pharmacists. 2019;76(9): 613–616. https://doi.org/10.1093/ajhp/zxz027.




2020     |     www.medigraphic.com