Time to abandon routine urine analysis prior to Bacillus Calmette-Guérin administration in asymptomatic patients

This study aims to determine whether asymptomatic bacteriuria (ABU) increases the risk of infective complications requiring hospitalisation in patients undergoing Bacillus Calmette-Guérin (BCG) instillations and consequently evaluate the need to screen asymptomatic patients for bacteriuria prior to BCG administration.

We analysed retrospectively all patients who received ≥1 BCG instillations as treatment of NMIBC in Helsinki University Hospital and Turku University Hospital during 2009-2018. Patients submitted urine specimens 1-7 days prior to every BCG instillation. Urine culture results and possible antibiotic prophylaxis prior to BCG administration were recorded. ABU was classified as having a positive urine culture but no dysuria or fever. All hospital admissions because of urinary tract infections and other BCG-related adverse effects within 2 weeks of BCG administration were recorded.

We analysed 802 patients and 12 968 BCG instillations. ABU was recorded prior to 2428 (19%) instillations among which antibiotics were used in 527 (22%). Hospital admission was recorded after 9 (0,3%) and 39 (0,4%) instillations in the ABU and in the sterile urine groups, respectively (P = 0.9). Antibiotic prophylaxis did not affect the hospital admission rate (P = 0.2).

BCG instillation with ABU is safe, and the results do not support routine screening of asymptomatic patients for bacteriuria prior to intravesical BCG immunotherapy.