Peri-interventional antibiotic prophylaxis in endoscopic valve implantation for lung volume reduction in COPD patients: results from a German multicenter observational cohort.

BACKGROUND

Endoscopic lung volume reduction (ELVR) using endobronchial valves is an established treatment for advanced COPD and emphysema. To reduce procedure-related complications such as pneumonia or exacerbations, peri-interventional antibiotic prophylaxis is commonly used; however, its clinical benefit remains uncertain. We aimed to evaluate the effect of different peri-interventional antibiotic strategies in a German COPD cohort.

METHODS

Comparative analyses were performed using data from 900 patients enrolled in the multicentre, observational German Lung Emphysema Registry (LE-Registry). Patients were categorized by peri-interventional antibiotic strategy: single-dose prophylaxis, prolonged prophylaxis for 5-7 days, or no prophylaxis. Baseline characteristics, airway colonization, lung function, symptom burden, exercise capacity, and adverse events were assessed up to three months after ELVR.

RESULTS

Among 900 patients undergoing ELVR, 104 received single-dose prophylaxis, 344 prolonged 5-7-day prophylaxis, and 309 no antibiotic prophylaxis. Clinical improvements in lung function, symptom burden, and exercise capacity over three months were similar across all groups. Exacerbations occurred in 11.5% of patients receiving single-dose prophylaxis (12/104), 7.6% with prolonged prophylaxis (26/344), and 5.5% without prophylaxis (17/309; p = 0.12). Pneumonia was observed in 7.7% (8/104), 3.2% (11/344), and 3.2% (10/309), respectively (p = 0.087). Antibiotic-related adverse events were infrequent and mild, occurring only in the prolonged prophylaxis group.

CONCLUSION

Peri-interventional antibiotic prophylaxis, whether single-dose or prolonged, did not improve clinical outcomes or reduce complication rates following ELVR. These findings indicate limited clinical benefit and support a more targeted, indication-based use of antibiotics in this setting.