Bacillus Calmette-Guerin infection following intravesical instillation: Does the strain matter?

Abstract Purpose Intravesical BCG is the standard treatment of non-muscle invasive bladder cancer. No difference has yet been reported in the safety profiles of the various BCG strains. Methods A nationwide multidisciplinary retrospective survey was conducted between January 2013 and December 2016 to identify cases of BCG infection and differentiate them based on the type of BCG strain used. Results Forty patients were identified (BCG RIVM 28; other strains 8; unknown 4). Patients treated with BCG RIVM were less severely ill, with fewer occurrences of septic shock (3.6% vs. 50%, P  = 0.003) and ICU admission (7.1% vs. 62.5%, P  = 0.003). A higher frequency of pulmonary miliaries (71.4% vs. 12.5%, P  = 0.005) but lower transaminase levels (mean AST 65 vs. 264 U/L, P  = 0.001) were observed in these patients. No difference in terms of recovery was reported. Conclusion The type of BCG strain could correlate with the frequency and severity of subsequent BCG infections.