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.