Severe Infectious Complications of Intravesical Bacillus Calmette-Guérin: A Case Series of 10 Patients

Urology. 2020 Mar;137:79-83. doi: 10.1016/j.urology.2019.10.013. Epub 2019 Nov 6.


Objective: To investigate severe infectious complications after intravesical treatment with bacillus Calmette-Guérin (BCG). We examine a retrospective case series of 10 patients between 2006 and 2018 with severe cystitis or systemic infection after BCG.

Methods: Patients with BCG cystitis or disseminated infection were retrospectively identified between 2006 and 2018 at our institution. Cases were reviewed for bladder cancer treatments, demographics, treatment of infection, and outcomes.

Results: There was a 0.8% rate of severe BCG cystitis or disseminated infection. Seven patients experienced delayed-onset infections >3 months after last BCG instillation. Four had isolated bladder symptoms, and 5 had diverse systemic manifestations. One patient was asymptomatic and diagnosed on cystoscopic findings. All were treated with varied antibiotic regimens; 9 included antituberculous therapy, and 1 was treated with levofloxacin alone. Two underwent cystectomy for end-stage bladder. The remaining patients are asymptomatic with no residual effects. All are in remission for bladder cancer.

Conclusion: Severe infectious complications after BCG are rare and thus difficult to study. Treatment regimens can vary widely. Thorough reporting of patient outcomes is essential to expand the limited body of knowledge.

MeSH terms

  • Adjuvants, Immunologic / administration & dosage
  • Adjuvants, Immunologic / adverse effects
  • Administration, Intravesical
  • Aged
  • Anti-Bacterial Agents* / administration & dosage
  • Anti-Bacterial Agents* / classification
  • BCG Vaccine* / administration & dosage
  • BCG Vaccine* / adverse effects
  • Cystectomy / methods*
  • Cystitis* / diagnosis
  • Cystitis* / etiology
  • Cystitis* / physiopathology
  • Cystitis* / therapy
  • Female
  • Humans
  • Male
  • Outcome and Process Assessment, Health Care
  • Retrospective Studies
  • Sepsis* / diagnosis
  • Sepsis* / etiology
  • Sepsis* / physiopathology
  • Sepsis* / therapy
  • Severity of Illness Index
  • Urinary Bladder Neoplasms / therapy*


  • Adjuvants, Immunologic
  • Anti-Bacterial Agents
  • BCG Vaccine