Intravesical BCG: A Double-Edged Sword? The Untold Story of Infection Risks
<i>Background and Objectives:</i> Intravesical Bacillus Calmette-Guérin (BCG) therapy remains a cornerstone in the treatment of non-muscle-invasive bladder carcinoma due to its efficacy in reducing recurrence and progression rates. However, its use is associated with various complication...
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MDPI AG
2025-02-01
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| author | Orçun Barkay Ercüment Keskin |
| author_facet | Orçun Barkay Ercüment Keskin |
| author_sort | Orçun Barkay |
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| description | <i>Background and Objectives:</i> Intravesical Bacillus Calmette-Guérin (BCG) therapy remains a cornerstone in the treatment of non-muscle-invasive bladder carcinoma due to its efficacy in reducing recurrence and progression rates. However, its use is associated with various complications—including urinary tract infections (UTIs)—which necessitates further exploration. This study aims to analyze UTIs occurring during intravesical BCG treatment, emphasizing the microbial spectrum, resistance patterns, and risk factors from an infectious diseases and clinical microbiology perspective. <i>Materials and Methods:</i> A retrospective analysis was conducted on 240 patients diagnosed with non-muscle-invasive bladder carcinoma who received intravesical BCG therapy between 2010 and 2021. Data were collected from hospital records, including demographic characteristics, comorbidities, number of intravesical BCG cycles, and microbiological findings. UTIs were classified based on susceptibility patterns, and statistical analyses were performed to determine associations between clinical variables and UTI risk. <i>Results:</i> UTIs developed in 39.1% (<i>n</i> = 94) of patients, with 25.8% (<i>n</i> = 62) caused by susceptible pathogens and 13.3% (<i>n</i> = 32) by resistant pathogens. The most common causative agent was <i>Escherichia coli</i> (80.7% in susceptible UTIs, 43.8% in resistant UTIs), followed by <i>Pseudomonas aeruginosa</i> and <i>Klebsiella pneumoniae</i>. The presence of diabetes mellitus and chronic kidney disease significantly increased the risk of developing a UTI (<i>p</i> < 0.05). A higher number of intravesical BCG cycles correlated with increased UTI occurrence (<i>p</i> < 0.001). Serum C-reactive protein (CRP) levels were significantly elevated in patients with resistant UTIs, while procalcitonin levels were not a reliable predictor of UTI occurrence. <i>Conclusions:</i> Intravesical BCG therapy is associated with a significant incidence of UTIs, particularly among patients with predisposing comorbidities. The increasing prevalence of antibiotic-resistant infections underscores the need for careful monitoring and targeted antimicrobial stewardship strategies. CRP may serve as a useful adjunctive marker for UTI diagnosis in this setting. Future studies should focus on optimizing infection control measures and refining diagnostic criteria to differentiate between BCG-related inflammation and infectious complications. |
| format | Article |
| id | doaj-art-ce4e52441dcb4a6caff3494c903da183 |
| institution | Kabale University |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | MDPI AG |
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| series | Medicina |
| spelling | doaj-art-ce4e52441dcb4a6caff3494c903da1832025-08-20T03:43:10ZengMDPI AGMedicina1010-660X1648-91442025-02-0161337910.3390/medicina61030379Intravesical BCG: A Double-Edged Sword? The Untold Story of Infection RisksOrçun Barkay0Ercüment Keskin1Infectious Diseases and Clinical Microbiology Department, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan 24002, TurkeyUrology Department, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan 24002, Turkey<i>Background and Objectives:</i> Intravesical Bacillus Calmette-Guérin (BCG) therapy remains a cornerstone in the treatment of non-muscle-invasive bladder carcinoma due to its efficacy in reducing recurrence and progression rates. However, its use is associated with various complications—including urinary tract infections (UTIs)—which necessitates further exploration. This study aims to analyze UTIs occurring during intravesical BCG treatment, emphasizing the microbial spectrum, resistance patterns, and risk factors from an infectious diseases and clinical microbiology perspective. <i>Materials and Methods:</i> A retrospective analysis was conducted on 240 patients diagnosed with non-muscle-invasive bladder carcinoma who received intravesical BCG therapy between 2010 and 2021. Data were collected from hospital records, including demographic characteristics, comorbidities, number of intravesical BCG cycles, and microbiological findings. UTIs were classified based on susceptibility patterns, and statistical analyses were performed to determine associations between clinical variables and UTI risk. <i>Results:</i> UTIs developed in 39.1% (<i>n</i> = 94) of patients, with 25.8% (<i>n</i> = 62) caused by susceptible pathogens and 13.3% (<i>n</i> = 32) by resistant pathogens. The most common causative agent was <i>Escherichia coli</i> (80.7% in susceptible UTIs, 43.8% in resistant UTIs), followed by <i>Pseudomonas aeruginosa</i> and <i>Klebsiella pneumoniae</i>. The presence of diabetes mellitus and chronic kidney disease significantly increased the risk of developing a UTI (<i>p</i> < 0.05). A higher number of intravesical BCG cycles correlated with increased UTI occurrence (<i>p</i> < 0.001). Serum C-reactive protein (CRP) levels were significantly elevated in patients with resistant UTIs, while procalcitonin levels were not a reliable predictor of UTI occurrence. <i>Conclusions:</i> Intravesical BCG therapy is associated with a significant incidence of UTIs, particularly among patients with predisposing comorbidities. The increasing prevalence of antibiotic-resistant infections underscores the need for careful monitoring and targeted antimicrobial stewardship strategies. CRP may serve as a useful adjunctive marker for UTI diagnosis in this setting. Future studies should focus on optimizing infection control measures and refining diagnostic criteria to differentiate between BCG-related inflammation and infectious complications.https://www.mdpi.com/1648-9144/61/3/379chronic kidney diseaseC-reactive proteindiabetes mellitusintravesical BCG therapynon-muscle-invasive bladder carcinomaurinary tract infections |
| spellingShingle | Orçun Barkay Ercüment Keskin Intravesical BCG: A Double-Edged Sword? The Untold Story of Infection Risks Medicina chronic kidney disease C-reactive protein diabetes mellitus intravesical BCG therapy non-muscle-invasive bladder carcinoma urinary tract infections |
| title | Intravesical BCG: A Double-Edged Sword? The Untold Story of Infection Risks |
| title_full | Intravesical BCG: A Double-Edged Sword? The Untold Story of Infection Risks |
| title_fullStr | Intravesical BCG: A Double-Edged Sword? The Untold Story of Infection Risks |
| title_full_unstemmed | Intravesical BCG: A Double-Edged Sword? The Untold Story of Infection Risks |
| title_short | Intravesical BCG: A Double-Edged Sword? The Untold Story of Infection Risks |
| title_sort | intravesical bcg a double edged sword the untold story of infection risks |
| topic | chronic kidney disease C-reactive protein diabetes mellitus intravesical BCG therapy non-muscle-invasive bladder carcinoma urinary tract infections |
| url | https://www.mdpi.com/1648-9144/61/3/379 |
| work_keys_str_mv | AT orcunbarkay intravesicalbcgadoubleedgedswordtheuntoldstoryofinfectionrisks AT ercumentkeskin intravesicalbcgadoubleedgedswordtheuntoldstoryofinfectionrisks |