Peri-interventional antibiotic prophylaxis in endoscopic valve implantation for lung volume reduction in COPD patients: results from a German multicenter observational cohort - Report - MDSpire
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Peri-interventional antibiotic prophylaxis in endoscopic valve implantation for lung volume reduction in COPD patients: results from a German multicenter observational cohort
Antibiotic Prophylaxis in Endoscopic Valve Implantation for COPD: LE-Registry Findings
Overview
This multicenter observational study evaluated the impact of peri-interventional antibiotic prophylaxis strategies on complications and short-term outcomes in COPD patients undergoing endoscopic lung volume reduction (ELVR) with valves. Results showed no conclusive clinical benefit of either single-dose or prolonged antibiotic prophylaxis compared to no antibiotics in reducing adverse events or improving functional outcomes.
Background
Endoscopic lung volume reduction using one-way valves is an established treatment for severe COPD with emphysema, improving lung function and quality of life. However, procedure-related complications such as acute exacerbations and pneumonia remain concerns, often prompting routine peri-interventional antibiotic use despite limited evidence. Previous trials have inconsistently reported antibiotic prophylaxis regimens, and current guidelines do not recommend routine antibiotics for bronchoscopic procedures. This study aimed to systematically assess the effects of different antibiotic prophylaxis strategies in a real-world multicenter cohort.
Data Highlights
Antibiotic Strategy
Number of Patients
Duration
Common Antibiotics Used
No Antibiotics
Group size not specified
0 days
None
Single-Dose Prophylaxis
Group size not specified
Single dose during procedure
Second- or third-generation cephalosporins, fluoroquinolones
Prolonged Prophylaxis
Group size not specified
5–7 days post-procedure
Varied; not standardized
Key Findings
Peri-interventional antibiotic prophylaxis was widely used but varied across centers without standardization.
No significant reduction in post-procedural pneumonia or acute exacerbations was observed with either single-dose or prolonged antibiotic prophylaxis compared to no antibiotics.
Functional outcomes at 3 months, including lung function, exercise capacity, and symptom scores, showed no clear benefit from antibiotic prophylaxis.
Microbiological analyses of bronchial samples revealed chronic airway colonization but did not correlate with prophylaxis strategy or outcomes.
Length of hospital stay was not significantly influenced by the antibiotic regimen used.
Clinical Implications
Routine peri-interventional antibiotic prophylaxis during ELVR in severe COPD patients may not confer additional clinical benefits in preventing complications or improving short-term functional outcomes. Clinicians should consider current guideline recommendations and weigh the risks of antibiotic overuse against uncertain benefits. Individualized patient assessment remains essential to optimize peri-procedural management.
Conclusion
This large multicenter observational study found no conclusive evidence supporting routine antibiotic prophylaxis during ELVR with valves in COPD patients. These findings highlight the need for further controlled trials to define optimal peri-interventional antibiotic strategies.
References
Klooster et al. -- Endoscopic Lung Volume Reduction Studies
VENT Trial -- Landmark ELVR Antibiotic Protocol
German Guideline on Perioperative Antibiotic Prophylaxis 2022
by Eva Pappe, Hadis Darvishi, Thomas Sgarbossa, Jacopo Saccomano, Kaid Darwiche, Stefan Andreas, Stephan Eisenmann, Bernd Schmidt, Wolfgang Gesierich, Nicolas Dickgreber, Christian Geltner, Joachim Hans Ficker, Angelique Holland, Björn Schwick, Stephan Eggeling, Ralf Eberhardt, Christian Grah, Christoph Hünermann, Urte Sommerwerck, Andreas Fertl, Sylke Kurz, Peter Schramm, Dinah von Schöning, Leif Erik Sander, Martin Witzenrath, Ralf-Harto Hübner
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