背景:卡介苗(BCG)是牛分枝杆菌的减毒活菌株,已被用作针对几种恶性肿瘤的免疫疗法。特别是,膀胱内滴注BCG已成为公认的膀胱癌辅助治疗方法。BCG血管感染是BCG治疗的罕见并发症。这些感染的许多方面,包括演讲,危险因素,和治疗策略,知之甚少。通过对现有文献的系统回顾,我们旨在确定这种情况与患者特征之间的潜在关联,介绍,其治疗,和结果。
方法:我们搜索了PubMed,MEDLINE,和Embase数据库从开始到2021年6月的BCG血管感染病例。包括BCG血管感染的英语报告。
结果:共纳入74例BCG血管感染病例。73例(99%)为男性患者,所有这些人都通过膀胱滴注暴露于卡介苗。50例(68%)在暴露于BCG后超过12个月被诊断出。26例(35%)在诊断时出现动脉破裂。在37例(50%)病例中,非血管部位同时存在BCG感染。BCG血管感染最常见的部位是腹主动脉(57%),假体移植物(15%),和胸主动脉(12%)。BCG感染最常见的治疗方法是开放式修复,原位置换腹主动脉和腔内修复胸主动脉。30天死亡率,在报告这些数据的59个案例中,是10%。
结论:我们观察到卡介苗血管感染的许多方面与其他形式的血管感染相似。破裂或瘘的高发生率以及腹主动脉受累的倾向及其预后与其他血管感染中描述的相似。然而,我们的研究还强调了BCG血管感染的2个特质特征:与男性和并发肌肉骨骼感染的相关性.
BACKGROUND: Bacillus Calmette-Guerin (BCG) is a live attenuated strain of Mycobacterium bovis that has been used as immunotherapy against several malignancies. In particular, intravesical instillation of BCG has become a well-accepted adjuvant treatment for bladder cancer. BCG vascular infections are a rare complication of BCG therapy. Many aspects of these infections, including the presentations, risk factors, and treatment strategies, are poorly understood. Through a systematic review of the existing literature, we aimed to identify potential associations between this condition and patient characteristics, presentations, its treatments, and outcomes.
METHODS: We searched the PubMed, MEDLINE, and Embase databases for cases of BCG vascular infections from inception to June 2021. English-language
reports of BCG vascular infections were included.
RESULTS: A total of 74 cases of BCG vascular infections were included. Seventy-three (99%) cases were male patients, all of whom were exposed to BCG through bladder instillation. Fifty (68%) cases were diagnosed more than 12 months after exposure to BCG. Twenty-six (35%) cases presented with arterial rupture at the time of diagnosis. Concurrent BCG infections in nonvascular locations were present in 37 (50%) cases. The most common locations of BCG vascular infection were the abdominal aorta (57%), prosthetic grafts (15%), and thoracic aorta (12%). The most common treatment for BCG infection was open repair with synthetic graft in situ replacement for the abdominal aorta and endovascular repair for the thoracic aorta. The 30-day mortality, among the 59 cases where these data were reported, was 10%.
CONCLUSIONS: We observed that many aspects of BCG vascular infections are similar to other forms of vascular infections. The high incidence of rupture or fistulation and the propensity toward abdominal aortic involvement and its prognosis are similar to those described in other vascular infections. However, our study also highlights 2 idiosyncratic features of BCG vascular infections: association with male sex and concurrent musculoskeletal infections.