<i>Mycobacterium bovis</i> Infections Following Intravesical Bacillus Calmette-Guérin Instillation for Bladder Cancer in Western Australia: A 22-Year Retrospective Review

Abstract Mycobacterium bovis bacillus Calmette-Guérin (BCG) infection following intravesical BCG instillation is a rare complication of therapy that is associated with significant morbidity and mortality. We conducted a multicenter retrospective review of microbiologically confirmed M.bovis BCG infections in Western Australia over 22 years. Thirty-three patients were included in our study. All patients were male with a median age of 72 years. Localized infections accounted for 22/33 cases while disseminated infections accounted for 11/33 cases. The majority (n = 21) of positive isolates were cultured from urine specimens, followed by tissue and blood. The median time between first BCG instillation and infection was 7.5 months (95% CI, 3.5–11.5). The median duration of antimycobacterial therapy for localized infections was 6 months (95% CI, 4.1–7.9) as compared with 9 months (95% CI, 7.9–10.1) for disseminated infections (P = .039). The attributed mortality was 14.3%. M.bovis BCG infections have diverse clinical presentations and clinicians must have a high index of suspicion when assessing patients with a history of intravesical BCG instillation.