000			nab a22 7a 4500
999			_c15925 _d15925
003			PC15925
005			20210625062814.0
008			200511b xxu||||| |||| 00| 0 eng d
040			_cH12O
041			_aeng
100			_9195 _aPérez-Jacoiste Asín, María Asunción _eMedicina Interna
100			_9263 _aFernández Ruiz, Mario _eMedicina Interna
100			_9162 _aLópez Medrano, Francisco _eEnfermedades Infecciosas
100			_9873 _aLumbreras Bermejo, Carlos _eMedicina Interna
100			_9484 _aTejido Sánchez, Ángel _eUrología
100			_9869 _aSan Juan Garrido, Rafael _eMedicina Interna
100			_92204 _aArrébola Pajares, Ana _eUrología
100			_9870 _aLizasoaín Hernández, Manuel _eMedicina Interna
100			_91952 _aPrieto Rodríguez, Santiago _eMedicina Interna
100			_9876 _aAguado García, José María _eEnfermedades Infecciosas
245	0	0	_aBacillus Calmette-Guérin (BCG) infection following intravesical BCG administration as adjunctive therapy for bladder cancer: incidence, risk factors, and outcome in a single-institution series and review of the literature. _h[artículo]
260			_bMedicine (Baltimore), _c2014
300			_a93(17):236-54.
500			_aFormato Vancouver: Pérez-Jacoiste Asín MA, Fernández-Ruiz M, López-Medrano F, Lumbreras C, Tejido A et al. Bacillus Calmette-Guérin (BCG) infection following intravesical BCG administration as adjunctive therapy for bladder cancer: incidence, risk factors, and outcome in a single-institution series and review of the literature. Medicine (Baltimore). 2014 Oct;93(17):236-54.
501			_aPMID: 25398060 PMC4602419
504			_aContiene 233 referencias
520			_aBacillus Calmette-Guérin (BCG) is the most effective intravesical immunotherapy for superficial bladder cancer. Although generally well tolerated, BCG-related infectious complications may occur following instillation. Much of the current knowledge about this complication comes from single case reports, with heterogeneous diagnostic and therapeutic approaches and no investigation on risk factors for its occurrence. We retrospectively analyzed 256 patients treated with intravesical BCG in our institution during a 6-year period, with a minimum follow-up of 6 months after the last instillation. We also conducted a comprehensive review and pooled analysis of additional cases reported in the literature since 1975. Eleven patients (4.3%) developed systemic BCG infection in our institution, with miliary tuberculosis as the most common form (6 cases). A 3-drug antituberculosis regimen was initiated in all but 1 patient, with a favorable outcome in 9/10 cases. There were no significant differences in the mean number of transurethral resections prior to the first instillation, the time interval between both procedures, the overall mean number of instillations, or the presence of underlying immunosuppression between patients with or without BCG infection. We included 282 patients in the pooled analysis (271 from the literature and 11 from our institution). Disseminated (34.4%), genitourinary (23.4%), and osteomuscular (19.9%) infections were the most common presentations of disease. Specimens for microbiologic diagnosis were obtained in 87.2% of cases, and the diagnostic performances for acid-fast staining, conventional culture, and polymerase chain reaction (PCR)-based assays were 25.3%, 40.9%, and 41.8%, respectively. Most patients (82.5%) received antituberculosis therapy for a median of 6.0 (interquartile range: 4.0-9.0) months. Patients with disseminated infection more commonly received antituberculosis therapy and adjuvant corticosteroids, whereas those with reactive arthritis were frequently treated only with nonsteroidal antiinflammatory drugs (p < 0.001 for all comparisons). Attributable mortality was higher for patients aged ≥65 years (7.4% vs 2.1%; p = 0.091) and those with disseminated infection (9.9% vs 3.0%; p = 0.040) and vascular involvement (16.7% vs 4.6%; p = 0.064). The scheduled BCG regimen was resumed in only 2 of 36 patients with available data (5.6%), with an uneventful outcome. In the absence of an apparent predictor of the development of disseminated BCG infection after intravesical therapy, and considering the protean variety of clinical manifestations, it is essential to keep a high index of suspicion to initiate adequate therapy promptly and to evaluate carefully the risk-benefit balance of resuming intravesical BCG immunotherapy.
710			_9266 _aUnidad de Enfermedades Infecciosas
710			_96 _aServicio de Medicina Interna
710			_9220 _aServicio de Urología
710			_9625 _aInstituto de Investigación imas12
856			_uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602419/ _yAcceso libre
942			_2ddc _cART _n0