Trudzinski Franziska C, Seiler Frederik, Wilkens Heinrike, Metz Carlos, Kamp Annegret, Bals Robert, Gärtner Barbara, Lepper Philipp M, Becker Sören L
Department of Internal Medicine V - Pneumology, Allergology and Critical Care Medicine, ECLS Center Saar, University Medical Center Saarland and Saarland University.
Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany.
Int J Chron Obstruct Pulmon Dis. 2017 Dec 19;13:29-35. doi: 10.2147/COPD.S150705. eCollection 2018.
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.
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.
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.
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 (9%), (6%), and (6%). No multidrug resistance was observed, and 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.
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.
内镜下肺减容术（eLVR）是慢性阻塞性肺疾病（COPD）合并重度肺气肿特定患者的一种治疗选择。感染性加重在这些脆弱患者中是严重事件；因此，干预后常预防性使用抗生素。然而，关于eLVR时气道微生物定植的数据稀缺，且对于合理的抗生素方案尚无循证推荐。
本研究旨在对2012 - 2017年在德国一家大学医院接受支气管内瓣膜eLVR治疗的晚期肺气肿COPD患者进行临床和微生物学分析。
在eLVR前获取支气管吸出物并送检进行微生物学分析。对分离出的细菌进行药敏试验，并将病原体定植情况与临床参数进行回顾性比较。
47%（30/64）的患者至少发现一种潜在病原体。总体而言，革兰阴性菌是最常检测到的病原体。最常见的单一菌种是[具体菌种1]（9%）、[具体菌种2]（6%）和[具体菌种3]（6%）。未观察到多重耐药情况，且[具体菌种4]在<5%的样本中出现。与检测到病原体的患者相比，气道无微生物定植的患者气流受限、肺过度充气和慢性高碳酸血症更严重。
接受eLVR的患者气道微生物定植很常见，但与较差的功能状态无直接关联。耐药检测结果不支持在这些患者中常规使用抗假单胞菌抗生素。
