Microbiological airway colonization in COPD patients with severe emphysema undergoing endoscopic lung volume reduction

Int J Chron Obstruct Pulmon Dis. 2017 Dec 19:13:29-35. doi: 10.2147/COPD.S150705. eCollection 2018.

Abstract

Background: Endoscopic lung volume reduction (eLVR) is a therapeutic option for selected patients with COPD and severe emphysema. Infectious exacerbations are serious events in these vulnerable patients; hence, prophylactic antibiotics are often prescribed postinterventionally. However, data on the microbiological airway colonization at the time of eLVR are scarce, and there are no evidence-based recommendations regarding a rational antibiotic regimen.

Objective: The aim of this study was to perform a clinical and microbiological analysis of COPD patients with advanced emphysema undergoing eLVR with endobronchial valves at a single German University hospital, 2012-2017.

Patients and methods: Bronchial aspirates were obtained prior to eLVR and sent for microbiological analysis. Antimicrobial susceptibility testing of bacterial isolates was performed, and pathogen colonization was retrospectively compared with clinical parameters.

Results: At least one potential pathogen was found in 47% (30/64) of patients. Overall, Gram-negative bacteria constituted the most frequently detected pathogens. The single most prevalent species were Haemophilus influenzae (9%), Streptococcus pneumoniae (6%), and Staphylococcus aureus (6%). No multidrug resistance was observed, and Pseudomonas aeruginosa occurred in <5% of samples. Patients without microbiological airway colonization showed more severe airflow limitation, hyperinflation, and chronic hypercapnia compared to those with detected pathogens.

Conclusion: Microbiological airway colonization was frequent in patients undergoing eLVR but not directly associated with poorer functional status. Resistance testing results do not support the routine use of antipseudomonal antibiotics in these patients.

Keywords: COPD; Haemophilus influenzae; Pseudomonas aeruginosa; emphysema; endoscopic lung volume reduction; resistance.

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Bacteria / drug effects
  • Bacteria / growth & development
  • Bacteria / isolation & purification*
  • Bronchoscopy
  • Drug Resistance, Bacterial
  • Female
  • Germany
  • Hospitals, University
  • Humans
  • Lung / microbiology*
  • Lung / surgery
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Pneumonectomy / methods
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / microbiology*
  • Pulmonary Disease, Chronic Obstructive / surgery
  • Pulmonary Emphysema / diagnosis
  • Pulmonary Emphysema / microbiology*
  • Pulmonary Emphysema / surgery
  • Respiratory Tract Infections / diagnosis
  • Respiratory Tract Infections / microbiology*
  • Respiratory Tract Infections / surgery
  • Retrospective Studies

Substances

  • Anti-Bacterial Agents