Intravesical bacillus Calmette-Guérin (BCG) instillation: are we doing things right in Latin America?
DOI:
https://doi.org/10.48193/7av6ac32Keywords:
BCG vaccine, instillation, adherence, guidelinesAbstract
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
Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, et al. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study. JAMA oncology. 2017;3(4): 524–548. https://doi.org/10.1001/jamaoncol.2016.5688.
Burger M, Catto JWF, Dalbagni G, Grossman HB, Herr H, Karakiewicz P, et al. Epidemiology and risk factors of urothelial bladder cancer. European Urology. 2013;63(2): 234–241. https://doi.org/10.1016/j.eururo.2012.07.033.
Babjuk M, Burger M, Capoun O, Cohen D, Compérat EM, Dominguez Escrig JL, et al. European Association of Urology Guidelines on 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.
Lamm DL, Blumenstein BA, Crissman JD, Montie JE, Gottesman JE, Lowe BA, et al. Maintenance bacillus Calmette-Guerin immunotherapy for recurrent TA, T1 and carcinoma in situ transitional cell carcinoma of the bladder: a randomized Southwest Oncology Group Study. The Journal of Urology. 2000;163(4): 1124–1129.
Gomella LG. Is BCG a Hazardous Drug? Ask NIOSH, OSHA, and the USP. The Canadian Journal of Urology. 2019;26(2): 9687–9689.
Lange C, Aaby P, Behr MA, Donald PR, Kaufmann SHE, Netea MG, et al. 100 years of Mycobacterium bovis bacille Calmette-Guérin. The Lancet. Infectious Diseases. 2022;22(1): e2–e12. https://doi.org/10.1016/S1473-3099(21)00403-5.
Mignard S, Pichat C, Carret G. Mycobacterium bovis Infection, Lyon, France. Emerging Infectious Diseases. 2006;12(9): 1431–1433. https://doi.org/10.3201/eid1209.060209.
Leon P, Saint F, Audenet F, Roumiguié M, Allory Y, Loriot Y, et al. Recommandations du Comité de cancérologie de l’Association Française d’Urologie (CC-AFU) pour la bonne pratique des instillations intravésicales de mitomycine C, d’épirubicine et de BCG pour le traitement des tumeurs de la vessie n’infiltrant pas le muscle (TVNIM). Progrès en Urologie. 2022;32(5): 299–311. https://doi.org/10.1016/j.purol.2022.01.004.
Lauridsen SV, De Blok W, Retinger NL, Jensen BT, Turner B, Villa G, et al. Intravesical instillation 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-or-bacillus-calmette-g [Accessed 4th July 2025].
Villoldo GM, Gonzalez MI, Faune AV, Molina RC, Montoya LFM, Salcedo JGC, et al. Multicenter Retrospective Registry Study on BCG Use in Non-Muscle Invasive Bladder Cancer in Latin America: BLATAM (Bladder Cancer in Latin America) Group. International braz j urol. 2025;51(3): e20240615. https://doi.org/10.1590/s1677-5538.ibju.2024.0615.
Piñeros M, Laversanne M, Barrios E, Cancela M de C, Vries E de, Pardo C, et al. An updated profile of the cancer burden, patterns and trends in Latin America and the Caribbean. The Lancet Regional Health – Americas. 2022;13. https://doi.org/10.1016/j.lana.2022.100294.
Vigler M, Mulett H, Hausman MR. Chronic Mycobacterium infection of first dorsal web space after accidental Bacilli Calmette-Guérin injection in a health worker: case report. The Journal of Hand Surgery. 2008;33(9): 1621–1624. https://doi.org/10.1016/j.jhsa.2008.05.019.
Waecker NJ, Stefanova R, Cave MD, Davis CE, Dankner WM. Nosocomial transmission of Mycobacterium bovis bacille Calmette-Guerin to children receiving cancer therapy and to their health care providers. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 2000;30(2): 356–362. https://doi.org/10.1086/313652.
Vos MC, de Haas PEW, Verbrugh HA, Renders NHM, Hartwig NG, de Man P, et al. Nosocomial Mycobacterium bovis-bacille Calmette-Guérin infections due to contamination of chemotherapeutics: case finding and route of transmission. The Journal of Infectious Diseases. 2003;188(9): 1332–1335. https://doi.org/10.1086/379034.
Meije Y, Martínez-Montauti J, Caylà JA, Loureiro J, Ortega L, Clemente M, et al. Healthcare-Associated Mycobacterium bovis–Bacille Calmette-Guérin (BCG) Infection in Cancer Patients Without Prior BCG Instillation. Clinical Infectious Diseases. 2017;65(7): 1136–1143.
Aqua JK, Holdsworth J, Burd E, Jacob JT, Ray SM, Schechter MC. Mycobacterium bovis Bacillus Calmette-Guérin Cross-Contamination in the Operating Room: A Case Report. Journal of Investigative Medicine High Impact Case Reports. 2021;9: 23247096211066287. https://doi.org/10.1177/23247096211066287.
Adams EJ, Amerine LB. Process improvement strategy to prepare and administer bacillus Calmette-Guérin vaccine in compliance with United States Pharmacopeia chapter 800 standards. American journal of health-system pharmacy: AJHP: official journal of the American Society of Health-System Pharmacists. 2019;76(9): 613–616. https://doi.org/10.1093/ajhp/zxz027.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Revista Mexicana de Urología
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
