title: Screening urine analysis before bacille Calmette-Guérin instillation does not reduce the rate of infectious complications.
abstract: Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Infectious complication is a risk of bacille Calmette-Guérin instillation. Urine analysis in asymptomatic patients has been used as a measure to reduce infections. This study suggests that screening urine analysis prior to bacille Calmette-Guérin instillation did not affect the rate of urinary tract infections.
  
  
  OBJECTIVE
  • To discover if the routine use of urine analysis decreases the rate of urinary tract infection (UTI) complications after bacille Calmette-Guérin (BCG) administration.
  
  
  METHODS
  • A retrospective review of the outcomes of 202 patients undergoing BCG treatment for bladder cancer at two medical centres with different pre-BCG screening strategies was performed. • The medical records of 100 patients who received BCG by one urologist at Memorial Sloan-Kettering Cancer Center (MSKCC) were reviewed. No patient received a urine analysis immediately prior to BCG treatment. • Similarly, 102 patients who received BCG at Northwestern Memorial Hospital (NMH) were reviewed. Patients at NMH were screened by urine analysis for pyuria and bacteriuria before BCG treatment, and, if clinically indicated, BCG instillation was delayed for the results of the urine culture. • If the urine culture confirmed infection, then the patient was treated before restarting BCG instillation.
  
  
  RESULTS
  • At MSKCC, 100 patients underwent 600 BCG treatments. • After BCG administration, symptomatic UTI occurred in three patients (3%), successfully treated with antibiotics. • No patients developed BCG sepsis or required hospitalization due to infection. • At NMH, 102 patients underwent 612 BCG treatments. • Pre-BCG urine analysis was positive for pyuria (defined as white blood cells >5 per high-power field) in 27.8%, and positive for bacteriuria (defined as any bacteria on microscopy) in 18.1%. • Based on the results of pre-screening urine analysis, BCG instillation was delayed 15 times (2.5%). • Overall, three patients (3%) had culture-proven UTIs after BCG instillation. • No patients developed BCG sepsis or required hospitalization in either group and there were no significant differences in the frequency of UTIs.
  
  
  CONCLUSIONS
  • Urine analysis can safely be omitted before administration of BCG in asymptomatic patients. • Omission of urine analysis could save time and expense during the office-based treatment of bladder cancer.
authors.affiliation: Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
authors.forename: Lee C
authors.initials: LC
authors.lastname: Zhao
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Meeks
authors.forename: Brian T
authors.initials: BT
authors.lastname: Helfand
authors.forename: Finlay R
authors.initials: FR
authors.lastname: Ross
authors.forename: Harry W
authors.initials: HW
authors.lastname: Herr
authors.forename: Shilajit D
authors.initials: SD
authors.lastname: Kundu
mesh_terms: D000276:Adjuvants, Immunologic / Q000009:adverse effects*; D000283:Administration, Intravesical; D000368:Aged; D001500:BCG Vaccine / Q000009:adverse effects*; D001437:Bacteriuria / Q000517:prevention & control* / Q000652:urine; D042241:Early Diagnosis; D006801:Humans; D012189:Retrospective Studies; D016482:Urinalysis / Q000379:methods; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000652:urine*
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine