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

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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. Figures Figure 1 Introduction Endoscopic lung volume reduction (ELVR) with endobronchial valves (EBV) is an established treatment option for patients with severe chronic obstructive pulmonary disease (COPD) suffering from advanced emphysema, whereby one-way valves are bronchoscopically implanted to induce atelectasis of the most diseased lung regions [ 1 ]. Treatment with ELVR has shown significant and clinically relevant improvements in lung function, exercise capacity, physical activity, dyspnea severity, and quality of life in COPD patients [ 2 – 7 ]. In addition to appropriate patient selection, the management of procedure-related adverse events is essential. Among the most relevant complications following ELVR are acute exacerbations of COPD (AECOPD) and infections such as pneumonia, both ultimately requiring early valve removal [ 8 ]. To mitigate these risks, periprophylactic antibiotic therapy is frequently administered during ELVR and has become routine practice in many centers [ 1 ]. Based on the protocol used in the VENT trial, one of the first prospective randomized studies evaluating ELVR, antibiotics are administered peri-interventionally, typically as intravenous therapy immediately before the procedure and for 24 hours thereafter, followed by a post-interventional oral course for seven days [ 7 ]. Commonly used agents include broad-spectrum antibiotics such as aminopenicillins with clavulanic acid or third-generation cephalosporins [ 4 , 5 , 7 , 9 , 10 ]. This preventive approach may be particularly relevant for patients with severe COPD, who are presumed to be at increased risk for post-procedural complications due to impaired lung function and a higher prevalence of chronic airway colonization with pathogenic bacteria [ 11 ]. However, to date, there is no conclusive evidence that prophylactic antibiotic therapy provides a clinical benefit in the context of ELVR. Notably, the current German guideline on perioperative and periinterventional antibiotic prophylaxis does not recommend the use of prophylactic antibiotics for bronchoscopic procedures [ 12 ]. Nevertheless, peri-interventional antibiotic prophylaxis is widely used at many German ELVR centers, although clear evidence for its clinical benefit is currently lacking. To date, no study has systematically evaluated the impact of different prophylactic strategies in this setting. Given the limited evidence, we aimed to determine whether peri-interventional antibiotic therapy administered either as a single dose or as a prolonged 5–7-day regimen reduces complications and improves short-term outcomes compared with no prophylaxis in patients with severe COPD undergoing ELVR within the LE-Registry. Methods Study Design We included patients treated and followed within the LE-Registry (www.lungenemphysemregister.de) between 2011 and 2024 (Figure 1). The LE-Registry is an open-label, multicenter, observational cohort of COPD patients with severe emphysema undergoing lung volume reduction. Its primary aim is to evaluate outcomes across different techniques within an independently operated, non–industry-funded registry, ensuring assessments are free from external influence. Data were collected and managed using REDCap [13] hosted at Charité – Universitätsmedizin Berlin. Inclusion and exclusion criteria have been published previously [8, 14-19]. For this study, only patients who underwent ELVR with one-way valves were included. Demographics, lung function, symptom scores, 6-minute walk test (6MWD), clinical features, and comorbidities were recorded. Follow-up on clinical outcomes, including complications and adverse events within 3 months, was analyzed. Patients were grouped according to the peri-interventional antibiotic strategy received: no antibiotics, single-dose prophylaxis (administered during the procedure), or prolonged prophylaxis for 5–7 days. The choice of regimen was not standardized but followed local practice and the discretion of the treating physician. For Charité patients, missing registry information was supplemented by medical record review. Exclusion criteria were ELVR performed externally, other types of volume reduction, second ELVR-treatment, or missing documentation of antibiotic prophylaxis. Ethics approval and consent to participate The study was approved by the Ethics Committee of Charité – Universitätsmedizin Berlin (EA2/149/17 and EA4/024/22). All patients provided written informed consent. Identifiable information was anonymized, and the study adhered to the Declaration of Helsinki. Microbiological samples Only bronchial washing fluids obtained during flexible bronchoscopy prior to ELVR were analyzed. Samples were collected before EBV implantation and submitted for culture according to local standards. Results were interpreted using the Microbiological-Infectious Quality Standards (MIQ) 07-08: Infections of the Lower Respiratory Tract, Part I and Part II, 2010 [20]. Statistical analysis Analysis was performed using IBM SPSS Statistics (Version 27.0; IBM Corp., Armonk, NY, USA). Continuous variables were tested for normality using the Shapiro–Wilk test and are reported as mean ± standard deviation or median with range, as appropriate; categorical variables are presented as counts and percentages. Changes from baseline to the 3-month follow-up were calculated as absolute deltas (Δ), including changes in forced expiratory volume in 1 second (FEV₁; % predicted and liters), residual volume (RV; % predicted and liters), diffusing capacity of the lung for carbon monoxide (DLCO; % predicted and mmHg), partial pressure of carbon dioxide (pCO₂; mmHg), 6MWD, COPD assessment test score (CAT), modified Medical research council dyspnea score (mMRC), and St. George’s respiratory questionnaire total score (SGRQ). Group differences were assessed using one-way ANOVA for continuous variables and χ² or Fisher’s exact tests for categorical variables. Baseline airway colonization before ELVR was summarized descriptively. All statistical tests were two-sided, with p < 0.05 considered significant. Results Figure 1 summarizes ELVR patient cohorts from the LE-Registry, focusing on periinterventional antibiotic prophylaxis. A total of 900 patients were screened. After excluding 143 patients due to undocumented antibiotic therapy (n = 92), initial treatment at another hospital (n = 3), or second ELVR treatment (n = 48), 757 patients were included in the final analysis. Of these, 104 patients received single-shot prophylaxis, 344 received prolonged prophylaxis (5–7 days), and 309 patients received no antibiotic prophylaxis. The most commonly used antibiotic in both prophylaxis groups was ampicillin/sulbactam (see table 1S in the supplements). Baseline characteristics Baseline characteristics of patients undergoing ELVR within the LE-Registry are summarized in Table 1. Age, sex, and most comorbidities were comparable across groups. Pulmonary hypertension was significantly more frequent in the single-shot group (11.5%) than in the prolonged (2.9%) and no-prophylaxis groups (4.6%) (p = 0.001). Patients in the single-shot group had the lowest FEV₁% predicted, lower RV, and slightly reduced DLCO (p < 0.001; p = 0.029). Baseline pCO₂ levels were also lower in this group. CAT and SGRQ scores suggested slightly better symptom control and quality of life in the prolonged prophylaxis group, whereas no significant differences were observed for mMRC or 6-MWD. Table 1: Baseline characteristics of patients with ELVR ( All data presented as mean ± SD or median [Min. – Max.], unless stated otherwise; superscript letters a and b indicate significance) Single shot antibiotic prophylaxis Prolonged (5/7-days) antibiotic prophylaxis No antibiotic prophylaxis p-value Patients n 104 344 309 Age years 65.6 ± 6.5 65.5 ± 7.7 66.6 ± 7.8 0.20 Sex n (%) 0.20 Male 57 (54.8) 190 (55.9) 150 (49.0) Female 47 (45.2) 150 (44.1) 156 (51.0) Comorbidities n (%) α 1 -Antitrypsin deficiency 3 (3.0) 21 (6.2) 13 (4.3) 0.40 Cardiovascular disease 19 (18.3) 49 (14.4) 50 (16.3) 0.59 Pulmonary hypertension 12 a (11.5) 10 b (2.9) 14 b (4.6) 0.001 Atrial fibrillation 5 (4.8) 20 (5.9) 16 (5.2) 0.89 Arterial hypertension 51 (49.0) 148 (43.4) 140 (45.6) 0.58 Osteoporosis 15 (14.4) 41 (12.0) 31 (10.1) 0.46 Diabetes mellitus type II 9 (8.7) 21 (6.2) 20 (6.5) 0.67 Previous history of lung cancer 1 (1.0) 2 (0.6) 2 (0.7) 0.92 Lung cancer 0 3 (0.9) 2 (0.7) 0.63 Lung function at baseline FEV 1 % of pred 27.0 a [14.0-46.0] 28.0 b [13.0-78.0] 29.7 b [11.0-76.2] 0.02 FEV 1 (L) 0.7 [0.3-2.4] 0.8 [0.3-1.8] 0.8 [0.4-2.7] 0.18 RV % of pred 221.0 a [57.0-386.0] 242.5 b [72.9-500.0] 243.0 b [75.4-627.0] <0.001 RV (L) 5.0 a [1.4-9.0] 5.5 b [2.1-19.0] 5.5 b [2.3-12.4] <0.001 DLCO % of pred 31.0 a [3.0-67.0] 28.0 a [2.0-95.0] 31.0 b [1.4-84.0] 0.03 DLCO mmHg 2.4 [0.2-5.8] 2.3 [0.2-62.3] 2.3 [0.1-9.3] 0.65 pCO 2 mmHg 38.0 a [5.-51.20] 41.0 b [5.3-96.5] 40.8 b [5.0-91.9] 0.001 6-MWD m 225.0 [0.0-480.0] 250.0 [25.0-574.0] 262.0 [15.0-510.0] 0.06 CAT points 26.5 a [10.0-40.0] 24.0 b [7.0-38.0] 26.0 b [6.0-40.0] 0.006 mMRC points 3.0 [1.0-4.0] 3.0 [0.0-4.0] 3.0 [1.0-4.0] 0.46 SGRQ points 67.3 a ± 10.6 64.1 b ± 13.2 67.6 a ± 13.8 0.03 Abbreviations: FEV ₁ = forced expiratory volume in 1 second; RV = residual volume; DLCO = diffusing capacity of the lung for carbon monoxide; pCO ₂ = partial pressure of carbon dioxide; 6-MWD = 6-minute walking distance; CAT = COPD Assessment Test; mMRC = modified Medical Research Council Dyspnea Scale; SGRQ = St. George’s Respiratory Questionnaire. Microbiological characterization of lower airway colonization before ELVR Across all groups, the most frequently detected pathogens in pre-interventional cultures were Escherichia coli (12.0% in the single-shot group, 8.8% in the prolonged group, and 14.3% in the no-prophylaxis group) and Staphylococcus aureus (13.3%, 9.4%, and 3.6%, respectively) (table 2). Other commonly isolated organisms included Haemophilus influenzae (5.3% in the single-shot group, 7.0% in the prolonged group, none in the no-prophylaxis group), Klebsiella pneumoniae (6.7%, 4.7%, and 3.6%), and Pseudomonas aeruginosa (2.7%, 4.7%, and none). Streptococcus pneumoniae and β-hemolytic streptococci were found in up to 7.1% of patients, while Moraxella catarrhalis, Stenotrophomonas maltophilia, and Aspergillus fumigatus were rarely detected. Table 2: Microbiological characterization of lower airway colonization before endoscopic lung volume reduction in patients treated with endobronchial valves (ß-haemolytic streptococci including S. pyogenes, S. agalactiae, S. dysgalactiae) Pathogens n (%) Single shot antibiotic prophylaxis Prolonged (5/7-days) antibiotic prophylaxis No antibiotic prophylaxis Staphylococcus aureus 10 (13.3%) 16 (9.4%) 1 (3.6%) Streptococcus pneumoniae 1 (1.3%) 5 (2.9%) 2 (7.1%) β-hemolytic streptococci 3 (5.3%) 3 (1.8%) 2 (7.1%) Haemophilus influenzae 4 (5.3%) 12 (7.0%) 0 (0.0%) Moraxella catarrhalis 0 (0.0%) 2 (1.2%) 1 (3.6%) Klebsiella pneumoniae 5 (6.7%) 8 (4.7%) 1 (3.6%) Escherichia coli 9 (12.0%) 15 (8.8%) 4 (14.3%) Pseudomonas aeruginosa 2 (2.7%) 8 (4.7%) 0 (0.0%) Stenotrophomonas maltophilia 0 (0.0%) 3 (1.8%) 0 (0.0%) Aspergillus fumigatus 1 (1.3%) 0 (0.0%) 1 (3.6%) Clinical outcomes Clinical outcomes at three months were comparable across all groups receiving different peri-interventional antibiotic strategies (table 3). All three groups showed similar improvements in lung function, exercise capacity, and symptom burden, regardless of the antibiotic regimen applied. Table 3: Clinical Outcomes after 3-month follow-up based on type of peri-interventional antibiotic therapy. Changes over time were assessed by Δ between baseline and 3-month follow-up.(All Data presented as mean ± SD or median [Min. – Max.], unless stated otherwise. * Missing values) Single shot antibiotic prophylaxis (n=104) * Prolonged (5/7-days) antibiotic prophylaxis (n=344) * No antibiotic prophylaxis (n=309) * p-value Δ FEV1 % of pred 3.5 [-13.0 – 54.0] 44 3.0 [-43.0 – 31.0] 15 3.0 [-18.0 – 38.1] 126 0.97 Δ FEV1 (L) 0.07 [-1.2 – 2.1] 43 0.08 [-0.4 – 1.1] 175 0.08 [-0.5 – 1.8] 117 0.98 Δ RV % of pred -31.0 [-152.0 – 145.0 44 -27.0 [-181.4 – 162.7] 158 -32.0 [-342.0 – 192.0 128 0.89 Δ RV (L) -0.7 [-4.5 – 3.5] 43 -0.56 [-4.1 – 2.5] 175 -0.7 [-6.70 – 3.6] 120 0.78 Δ DLCO % of pred 2.5 [-31.0 – 46.0] 52 1.00 [-43.0 – 49.0] 202 2.0 [-21.0 – 36.0] 186 0.64 Δ DLCO (mmHg) 0.3 [-3.0 – 4.7] 52 0.1 [-4.0 – 2.8] 221 0.2 [-1.9 – 5.6] 192 0.30 Δ pCO2 (mmHg) -0.3 [-11.4 – 9.1] 49 -1.80 [40.4 – 35.7] 169 -1.40 [52.6 – 32.6 142 0.56 Δ 6MWD m 12.5 [-220.0 – 161.0] 54 33.5 [-182.0- 330.0] 200 40.0 [-223.0 - 260.0] 186 0.11 Δ CAT points -3.1 ± 6.0 48 -3.0 ± 6.7 203 -3.3 ± 6.4 174 0.90 Δ mMRC points 0.0 [-3 .0 – 1.0] 71 -1.00 [-3.0 –4.0] 200 0.0 [-3.0 – 2.0] 195 0.15 Δ SGRQ points -9.3 [-39.5 – 12.8] 65 -8.2 [-57.4 –18.3] 260 -6.8 [-52.4 – 18.6] 220 0.78 Abbreviations: FEV ₁ = forced expiratory volume in 1 second; RV = residual volume; DLCO = diffusing capacity of the lung for carbon monoxide; pCO ₂ = partial pressure of carbon dioxide; 6-MWD = 6-minute walking distance; CAT = COPD Assessment Test; mMRC = modified Medical Research Council Dyspnea Scale; SGRQ = St. George’s Respiratory Questionnaire. Adverse events Adverse events within three months after ELVR are summarized in table 4. The incidence of pneumothorax, exacerbations, and pneumonia did not differ significantly between groups. Exacerbation and pneumonia rates were numerically highest in the single-shot group and lowest in the no-prophylaxis group, although these differences did not reach statistical significance (p = 0.12 and p = 0.09, respectively). Severe complications such as sepsis, hemoptysis, ICU admission, mechanical ventilation, and death were rare and occurred at similarly low frequencies across all groups. Length of hospital stay after ELVR was also comparable (see table S2 in the supplements). Table 4: Adverse events 3 months after endoscopic lung volume reduction in patients treated with endobronchial valves dependent on peri-interventional antibiotic therapy Single shot antibiotic prophylaxis Prolonged (5/7-days) antibiotic prophylaxis No antibiotic prophylaxis p-value Pneumothorax n (%) 19 (9.6) 55 (16.0) 41 (13.3) 0.23 Exacerbations n (%) 12 (11.5) 26 (7.6) 17 (5.5) 0.12 Pneumonia n (%) 8 (7.7) 11 (3.2) 10 (3.2) 0.09 Sepsis n (%) 1 (1.0) 0 (0.0) 0 (0.0) n.a. Hemoptysis n (%) 1 (1.0) 6 (1.7) 1 (0.3) n.a. ICU n (%) 3 (2.9) 8 (2.3) 7 (2.3) n.a. Mechanical ventilation n (%) 2 (1.9) 0 (0.0) 2 (0.7) n.a. Death n (%) 1 (1.0) 1 (0.3) 0 (0.0) n.a. Abbreviations: ICU = intensive care unit. Antibiotic-associated complications Antibiotic-associated complications were rare across all groups and are summarized in table 7. No cases of anaphylaxis were reported. Minor adverse events, such as skin rash (0.3%) and diarrhea (0.6%), occurred exclusively in the prolonged prophylaxis group. No such events were observed in the single-shot group. Table 7: Antibiotics-associated adverse events after endoscopic lung volume reduction in patients treated with endobronchial valves at Charité-Universitätsmedizin, Berlin (*Vaginal mycosis) Single shot antibiotic prophylaxis Prolonged (5/7-days) antibiotic prophylaxis No antibiotic prophylaxis p-value Skin rash n (%) 0 (0.0) 1 (0.3) 0 (0.0) n.a. Anaphylaxis n (%) 0 (0.0) 0 (0.0) 0 (0.0) n.a. Diarrhea n (%) 0 (0.0) 2 (0.6) 0 (0.0) n.a. Other* n (%) 0 (0.0) 1 (0.3) 0 (0.0) n.a. Discussion Peri-interventional antibiotic prophylaxis, whether as a single shot or over a prolonged period, did not significantly reduce complication rates after ELVR. Clinical outcomes, including lung function, symptom burden, and quality of life, were comparable across groups. Pneumonia and AECOPD incidence was low in patients without prophylaxis but comparatively higher for pneumonia in those receiving a single-shot regimen, while prolonged prophylaxis showed similar rates to no prophylaxis. Antibiotic-related side effects and airway colonization occurred infrequently and without relevant differences. ELVR is a less invasive alternative to surgical lung volume reduction for advanced emphysema [1]. Randomized trials reported FEV₁ improvements of 100–150 mL and RV reductions of 400–700 mL within 3–6 months [3-7, 21-23]. In our study, median improvement after 3 months was +80 mL in FEV₁ and –640 mL RV, independent of antibiotic prophylaxis, suggesting that infection control is not the main driver of functional benefit. There are no standardized recommendations on peri-interventional antibiotics in ELVR. In the first pilot study for ELVR, the VENT trial, prophylactic antibiotics were administered shortly before and up to 7 days after valve implantation [7]. The rationale for prolonged antibiotic therapy is based on the assumption that immobilization and the presence of foreign material may promote secretion retention and microbial colonization. Indeed, biofilm formation has been demonstrated on explanted endobronchial valves, supporting the concept that microbial communities can persist on device surfaces [24]. Subsequent large, randomized ELVR studies employed different prophylactic regimens. For instance, the IMPACT study used prolonged antibiotic therapy for 5 to 7 days [4], whereas the REACH trial administered only a single-dose antibiotic therapy during the bronchoscopy procedure [10]. Despite these varied approaches, no systematic investigation has been conducted to determine the effect of prophylactic antibiotic administration during ELVR. To our knowledge, our study is the first to evaluate whether different regimens of prophylactic antibiotics impact the outcomes after ELVR. Despite its minimally invasive nature, ELVR is associated with several potential complications that require careful consideration and management. One of the potential adverse events are exacerbations and pneumonia following EBV implantation, which can lead to EBV removal [8]. In our study, adverse event rates at 3 months ranged from 3.2–7.7% for pneumonia and 5.5–11.5% for AECOPD. We found that a single dose of antibiotics during ELVR may be as effective as prolonged peri-interventional antibiotic therapy. Moreover, there was no significant difference in adverse event rates between patients who received no prophylaxis and those who received antibiotic prophylaxis during ELVR. These findings suggest that if peri-interventional antibiotics are used during ELVR, a single dose is sufficient, and in some cases, they may not be necessary at all. Other reports have suggested benefit: Abia-Trujillo et al. found fewer exacerbations with prophylaxis [25], but their non-prophylaxis group was very small (n = 26) compared with ours (n = 309). Our larger data set therefore provides a more robust estimate of the effect of peri-interventional antibiotics. Chronic airway colonization is common in ELVR patients [11]. Long-term follow-up after EBV implantation showed increased prevalence of Staphylococcus aureus, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Moraxella catarrhalis, and anaerobes [26]. However, colonization was not directly associated with poorer function. Distinguishing colonization from infection remains challenging, and outcomes are influenced by host immunity and comorbidity burden. This study has several limitations. The observational design precludes causal inference, and the absence of randomization may introduce selection bias. In particular, the choice of peri-interventional antibiotic strategy was not standardized but depended on individual clinical judgement and center-specific practice, rather than on uniform criteria. As a result, systematic differences between groups may partly reflect center preferences rather than underlying patient characteristics. Registry-based data may incompletely capture comorbidities, baseline parameters, or adverse events. Follow-up documentation was less complete than baseline, limiting the ability to reliably assess long-term outcomes. Event rates for pneumonia and AECOPD were low, and some exacerbations were only captured when treated in hospital. Due to missing data and the small number of outcome events, robust multivariable regression or time-to-event analyses were not feasible. Center-level differences, including patient preparation, mobilization protocols, inhalation therapy, and physiotherapy, may have influenced outcomes independently of antibiotic use. Despite these limitations, the study has notable strengths. It represents the largest multicenter cohort to date evaluating peri-interventional antibiotic strategies in ELVR. The LE-Registry includes more than 700 well-characterized patients, providing comprehensive real-world data and enabling systematic assessment of outcomes and adverse events across different clinical practices. Although residual confounding cannot be ruled out, our results indicate that peri-interventional antibiotic prophylaxis, whether single-shot or prolonged, does not improve outcomes or reduce adverse events in routine ELVR. In line with antimicrobial stewardship, routine use should be questioned, as it adds side effects and fosters resistance without measurable benefit. Antibiotic treatment may still be considered in selected patients, such as those with suspected infection after EBV implantation or with chronic colonization, where a short targeted course or long-term modulatory therapy (e.g. azithromycin) could help manage adverse events. Such strategies should remain individualized rather than routine. To strengthen the evidence base, randomized controlled trials with larger cohorts and extended follow-up are needed. Future studies should better characterize exacerbations and infectious events, examine microbiological dynamics such as valve colonization and biofilm formation, and integrate measures of symptom burden and patient-reported outcomes. This multicenter study found no evidence that peri-interventional antibiotic prophylaxis reduces adverse events or improves outcomes after ELVR in severe COPD. Improvements in lung function, exercise capacity, and quality of life were observed across all groups, regardless of antibiotic use. Pneumonia and exacerbations remained infrequent and were not reduced by prophylaxis. Routine administration of antibiotics in this setting cannot therefore be recommended. Abbreviations AECOPD Acute Exacerbation of Chronic Obstructive Pulmonary Disease CAT COPD Assessment Test COPD Chronic Obstructive Pulmonary Disease DLCO Diffusing Capacity of the Lung for Carbon Monoxide EBV Endobronchial Valve ELVR Endoscopic Lung Volume Reduction FEV₁ Forced Expiratory Volume in 1 Second ICU Intensive Care Unit LE Registry–German Lung Emphysema Registry MIQ Microbiological–Infectious Quality Standards mMRC Modified Medical Research Council Dyspnea Scale RV Residual Volume SGRQ St. George’s Respiratory Questionnaire 6MWD Six–Minute Walking Distance Declarations Author contributions Conceptualization: E.P., R-H.H.; Data curation: E.P., H.D., T.S.; J.S. and R-H.H.; Data collection: E.P., H.D., T.S., J.S., K.D., S.A., S.E., B.S., W.G., N.D., C.G., J.F., A.H., B.S., S.E., R.E., C.G., C.H., U.S., A.F., S.K., P.S..; Formal analysis: E.P., H.D., T.S.; J.S. and R-H.H.; Funding acquisition: R-H.H. and M.W.; Methodology: E.P., H.D., D.S. and R-H.H.; Visualization: E.P., D.S. and H.D.; Writing - original draft: E.P. and R-H.H. ; Writing - review & editing: E.P., H.D., T.S., J.S., K.D., S.A., S.E., B.S., W.G., N.D., C.G., J.F., A.H., B.S., S.E., R.E., C.G., C.H., U.S., A.F., S.K., P.S., L.E.S.; Supervision: R-H.H. and M.W.. All authors have approved the final version of the manuscript. Conflicts of interest E.P.: No conflict of interest. H.D.: No conflict of interest. T.S.: No conflict of interest. J.S.: received payment or support for attending congresses from PulmonX and Boehringer Ingelheim, serves on the scientific advisory board of LE-Registry. K.D.: received payment or honoraria for lectures and consulting, from bess, Lys Medical, Olympus, PulmonX, Boston Scientific, Boehringer Ingelheim, Broncus Medical, Erbe, Storz, Fujifilm, Intuitive, payments to the institution from Boston Scientific, Boehringer Ingelheim, Broncus Medical, Erbe, Lys Medical, Olympus, PulmonX, Storz, participates on the societies: DGP, and World Association for Bronchology and Interventional Pneumology. S.A.: received payment or honoraria for lectures and consulting, from Sanofi, Boehringer Ingelheim, Novartis, AstraZeneca, GSK, Chiesi, Merini, support for attending congresses from Boehringer Ingelheim, speaker of the Section “Tabakentwöhnung” at DGP and board member of the ABNR. S.E.: received payment or honoraria for lectures from PulmonX. B.S.: No conflict of interest. W.G.: received payment or honoraria for lectures from Astra Zeneca, Boehringer Ingelheim, Bristol Myers Sqibb, PulmonX, Springer Medicine N.D.: No conflict of interest. C.G.: No conflict of interest. J.F.: No conflict of interest. A.H.: No conflict of interest. B.S.: No conflict of interest. S.E.: serves on the scientific advisory board of LE-Registry. R.E.: received payment or honoraria for lectures from AstraZeneca, CSL Behring, Olympus, Pulmonx, Pentax, serves on the scientific advisory board of LE-Registry. C.G.: No conflict of interest. C.H.: No conflict of interest. U.S.: No conflict of interest. A.F.: No conflict of interest. S.K.: No conflict of interest. P.S.: No conflict of interest. D.S.: No conflict of interest. L.E.S.: No conflict of interest. M.W.: received grants from Bundesministerium für Forschung, Technologie und Raumfahrt (BMFTR; Federal Ministry of Research, Technology and Space), Deutsche Forschungsgemeinschaft (DFG; German Research Foundation), Gemeinsamer Bundesausschuss (G-BA; The Federal Joint Committee), Bundesministerium für Gesundheit (BMG; Federal Ministry of Health), received payment or honoraria for lectures and consulting from Biotest, Pantherna, Aptarion, Biotest, Pantherna, Aptarion, Astra Zeneca, Chiesi, Insmed, Gilead, Pfizer, Boehringer Personal Fees R-H.H.: received study fee (Convert) from Pulmonx; received payment or honoraria for lectures from Berlin Chemie, Astra, Chiesi and Pulmonx; an received payment or support for attending congresses Medtronic. Funding This study was supported in part by grants from CAPNETZ Stiftung and LE-Registry. Acknowledgments We would like to thank all patients for their participation in this study. We also gratefully acknowledge all members of the LE-Registry and Monika Rummenholl (LE-Registry, Berlin, Germany) as well as Grit Barten-Neiner (CAPNETZ Lungenstiftung, Hannover, Germany), for their valuable support. Some of the data from the study have been presented by the author Eva Pappe as poster at the congress of the German respiratory society (DGP) in Wiesbaden 2024 and European Respiratory Society (ERS) Congress in Vienna 2024. Data Availability Statement Data can be made available on request to the corresponding author. References Herth FJF, et al. Endoscopic Lung Volume Reduction: An Expert Panel Recommendation - Update 2019. Respiration. 2019;97(6):548–57. Criner GJ, et al. A Multicenter Randomized Controlled Trial of Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema (LIBERATE). Am J Respir Crit Care Med. 2018;198(9):1151–64. Kemp SV, et al. A Multicenter Randomized Controlled Trial of Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema (TRANSFORM). Am J Respir Crit Care Med. 2017;196(12):1535–43. Valipour A, et al. Endobronchial Valve Therapy in Patients with Homogeneous Emphysema. Results from the IMPACT Study. Am J Respir Crit Care Med. 2016;194(9):1073–82. Klooster K, et al. Endobronchial Valves for Emphysema without Interlobar Collateral Ventilation. N Engl J Med. 2015;373(24):2325–35. Davey C, et al. Bronchoscopic lung volume reduction with endobronchial valves for patients with heterogeneous emphysema and intact interlobar fissures (the BeLieVeR-HIFi study): a randomised controlled trial. Lancet. 2015;386(9998):1066–73. Sciurba FC, et al. A randomized study of endobronchial valves for advanced emphysema. N Engl J Med. 2010;363(13):1233–44. Hübner RH, et al. Endoscopic Lung Volume Reduction: Can Endobronchial Valves Be Safely Removed? Respiration. 2020;99(5):459–60. Strange C, et al. Design of the Endobronchial Valve for Emphysema Palliation Trial (VENT): a non-surgical method of lung volume reduction. BMC Pulm Med. 2007;7(1):10. Li S, et al. The REACH Trial: A Randomized Controlled Trial Assessing the Safety and Effectiveness of the Spiration® Valve System in the Treatment of Severe Emphysema. Respiration. 2019;97(5):416–27. Trudzinski FC, et al. Microbiological airway colonization in COPD patients with severe emphysema undergoing endoscopic lung volume reduction. Int J Chron Obstruct Pulmon Dis. 2018;13:29–35. S3-Leitlinie Perioperative und Periinterventionelle Antibiotikaprophylaxe – Aktualisierung 2024. Langversion, 5.0. 2024. AWMF Registernummer: 067/009, DOI: https://register.awmf.org/de/leitlinien/detail/067-009 Harris PA, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inf. 2019;95:103208. Sgarbossa T, et al. Comparison of Efficacy and Safety of Different Types of One-Way Valves in Endoscopic Lung Volume Reduction in Patients with Severe Lung Emphysema. Respiration. 2025;104(4):281–9. Saccomanno J et al. Clinical improvements after endoscopic lung volume reduction with valves in patients with advanced emphysema and a 6-min walk test ≤ 140 m at baseline. ERJ Open Res, 2025. 11(1). Sgarbossa T et al. Assessment of efficacy and safety of endoscopic lung volume reduction with one-way valves in patients with a very low FEV(1). ERJ Open Res, 2023. 9(4). Pappe E, et al. Impact of Coronavirus Disease 2019 on Hospital Admissions, Health Status, and Behavioral Changes of Patients with COPD. Chronic Obstr Pulm Dis. 2023;10(3):211–23. Lenga P, et al. Endoscopic Lung Volume Reduction with One-Way Valves in Patients with Severe Chronic Obstructive Pulmonary Disease with Hypercapnia. Respiration. 2022;101(9):823–32. Lenga P et al. Endoscopic lung volume reduction with endobronchial valves in very low D (LCO) patients: results from the German Registry - Lungenemphysemregister e.V. ERJ Open Res, 2021. 7(1). Mikrobiologisch-infektiologische Qualitätsstandards: MiQ ; Qualitätsstandards in der mikrobiologisch-infektiologischen Diagnostik / Expertengremium Mikrobiologische-Infektiologische Qualitätsstandards (MiQ) ; Qualitätssicherungskommission der Deutschen Gesellschaft für Hygiene und Mikrobiologie (DGHM). Im Auftr. der Deutschen Gesellschaft für Hygiene und Mikrobiologie (DGHM) . München: Elsevier, Urban & Fischer. Nada KM, Nishi S. Endoscopic Lung Volume Reduction: Review of the EMPROVE and LIBERATE trials. Mayo Clin Proc Innov Qual Outcomes. 2021;5(1):177–86. Criner GJ, et al. Improving lung function in severe heterogenous emphysema with the spiration valve system (EMPROVE). A multicenter, open-label randomized controlled clinical trial. Am J Respir Crit Care Med. 2019;200(11):1354–62. Criner GJ, et al. A multicenter randomized controlled trial of zephyr endobronchial valve treatment in heterogeneous emphysema (LIBERATE). Am J Respir Crit Care Med. 2018;198(9):1151–64. Pappe E, et al. Biofilm infections of endobronchial valves in COPD patients after endoscopic lung volume reduction: a pilot study with FISHseq. Sci Rep. 2024;14(1):23078. Abia-Trujillo D, et al. Prevention of acute exacerbation of chronic obstructive pulmonary disease after bronchoscopic lung volume reduction with endobronchial valves. Clin Respir J. 2022;16(1):43–8. Sarmand N, et al. New bacterial growth in bronchial secretions after bronchoscopic valve implantation. Int J Chron Obstruct Pulmon Dis. 2018;13:565–70. Additional Declarations No competing interests reported. Supplementary Files Supplementmaterial.docx Cite Share Download PDF Status: Published Journal Publication published 13 Feb, 2026 Read the published version in Infection → Version 1 posted Editorial decision: Revision requested 15 Jan, 2026 Reviews received at journal 14 Jan, 2026 Reviewers agreed at journal 04 Jan, 2026 Reviews received at journal 30 Dec, 2025 Reviewers agreed at journal 15 Dec, 2025 Reviewers invited by journal 15 Dec, 2025 Editor assigned by journal 05 Dec, 2025 Submission checks completed at journal 05 Dec, 2025 First submitted to journal 04 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Registry\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8280597/v1/6b2014305c1643f7f6b24201.png"},{"id":102786128,"identity":"f80d0475-1494-4254-8deb-f5a0ff7cbd83","added_by":"auto","created_at":"2026-02-16 16:11:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1813819,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8280597/v1/f3260f5a-e6fd-4fa8-b256-8e58a84aa01c.pdf"},{"id":98777467,"identity":"93443c20-4cd5-4499-9ec1-97bf75889868","added_by":"auto","created_at":"2025-12-22 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class=\"CitationRef\"\u003e1\u003c/span\u003e]. Treatment with ELVR has shown significant and clinically relevant improvements in lung function, exercise capacity, physical activity, dyspnea severity, and quality of life in COPD patients [\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition to appropriate patient selection, the management of procedure-related adverse events is essential. Among the most relevant complications following ELVR are acute exacerbations of COPD (AECOPD) and infections such as pneumonia, both ultimately requiring early valve removal [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. To mitigate these risks, periprophylactic antibiotic therapy is frequently administered during ELVR and has become routine practice in many centers [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Based on the protocol used in the VENT trial, one of the first prospective randomized studies evaluating ELVR, antibiotics are administered peri-interventionally, typically as intravenous therapy immediately before the procedure and for 24 hours thereafter, followed by a post-interventional oral course for seven days [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Commonly used agents include broad-spectrum antibiotics such as aminopenicillins with clavulanic acid or third-generation cephalosporins [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis preventive approach may be particularly relevant for patients with severe COPD, who are presumed to be at increased risk for post-procedural complications due to impaired lung function and a higher prevalence of chronic airway colonization with pathogenic bacteria [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, to date, there is no conclusive evidence that prophylactic antibiotic therapy provides a clinical benefit in the context of ELVR. Notably, the current German guideline on perioperative and periinterventional antibiotic prophylaxis does not recommend the use of prophylactic antibiotics for bronchoscopic procedures [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Nevertheless, peri-interventional antibiotic prophylaxis is widely used at many German ELVR centers, although clear evidence for its clinical benefit is currently lacking. To date, no study has systematically evaluated the impact of different prophylactic strategies in this setting.\u003c/p\u003e \u003cp\u003eGiven the limited evidence, we aimed to determine whether peri-interventional antibiotic therapy administered either as a single dose or as a prolonged 5\u0026ndash;7-day regimen reduces complications and improves short-term outcomes compared with no prophylaxis in patients with severe COPD undergoing ELVR within the LE-Registry.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe included patients treated and followed within the LE-Registry (www.lungenemphysemregister.de) between 2011 and 2024 (Figure 1). The LE-Registry is an open-label, multicenter, observational cohort of COPD patients with severe emphysema undergoing lung volume reduction. Its primary aim is to evaluate outcomes across different techniques within an independently operated, non–industry-funded registry, ensuring assessments are free from external influence.\u003c/p\u003e\n\u003cp\u003eData were collected and managed using REDCap [13] hosted at Charité – Universitätsmedizin Berlin. Inclusion and exclusion criteria have been published previously\u0026nbsp;[8, 14-19]. For this study, only patients who underwent ELVR with one-way valves were included. Demographics, lung function, symptom scores, 6-minute walk test (6MWD), clinical features, and comorbidities were recorded. Follow-up on clinical outcomes, including complications and adverse events within 3 months, was analyzed. Patients were grouped according to the peri-interventional antibiotic strategy received: no antibiotics, single-dose prophylaxis (administered during the procedure), or prolonged prophylaxis for 5–7 days. The choice of regimen was not standardized but followed local practice and the discretion of the treating physician. For Charité patients, missing registry information was supplemented by medical record review. Exclusion criteria were ELVR performed externally, other types of volume reduction, second ELVR-treatment, or missing documentation of antibiotic prophylaxis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of Charité – Universitätsmedizin Berlin (EA2/149/17 and EA4/024/22). All patients provided written informed consent. Identifiable information was anonymized, and the study adhered to the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMicrobiological samples\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOnly bronchial washing fluids obtained during flexible bronchoscopy prior to ELVR were analyzed. Samples were collected before EBV implantation and submitted for culture according to local standards. Results were interpreted using the Microbiological-Infectious Quality Standards (MIQ) 07-08: \u003cem\u003eInfections of the Lower Respiratory Tract, Part I and Part II, 2010\u0026nbsp;\u003c/em\u003e[20].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnalysis was performed using IBM SPSS Statistics (Version 27.0; IBM Corp., Armonk, NY, USA). Continuous variables were tested for normality using the Shapiro–Wilk test and are reported as mean ± standard deviation or median with range, as appropriate; categorical variables are presented as counts and percentages. Changes from baseline to the 3-month follow-up were calculated as absolute deltas (Δ), including changes in forced expiratory volume in 1 second (FEV₁; % predicted and liters), residual volume (RV; % predicted and liters), diffusing capacity of the lung for carbon monoxide (DLCO; % predicted and mmHg), partial pressure of carbon dioxide (pCO₂; mmHg), 6MWD, COPD assessment test score (CAT), modified Medical research council dyspnea score (mMRC), and St. George’s respiratory questionnaire total score (SGRQ). Group differences were assessed using one-way ANOVA for continuous variables and χ² or Fisher’s exact tests for categorical variables. Baseline airway colonization before ELVR was summarized descriptively. All statistical tests were two-sided, with p \u0026lt; 0.05 considered significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFigure 1 summarizes ELVR patient cohorts from the LE-Registry, focusing on periinterventional antibiotic prophylaxis. A total of 900 patients were screened. After excluding 143 patients due to undocumented antibiotic therapy (n = 92), initial treatment at another hospital (n = 3), or second ELVR treatment (n = 48), 757 patients were included in the final analysis. Of these, 104 patients received single-shot prophylaxis, 344 received prolonged prophylaxis (5\u0026ndash;7 days), and 309 patients received no antibiotic prophylaxis. The most commonly used antibiotic in both prophylaxis groups was ampicillin/sulbactam (see table 1S in the supplements).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBaseline characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBaseline characteristics of patients undergoing ELVR within the LE-Registry are summarized in Table 1. Age, sex, and most comorbidities were comparable across groups. Pulmonary hypertension was significantly more frequent in the single-shot group (11.5%) than in the prolonged (2.9%) and no-prophylaxis groups (4.6%) (p = 0.001). Patients in the single-shot group had the lowest FEV₁% predicted, lower RV, and slightly reduced DLCO (p \u0026lt; 0.001; p = 0.029). Baseline pCO₂\u0026nbsp;levels were also lower in this group. CAT and SGRQ scores suggested slightly better symptom control and quality of life in the prolonged prophylaxis group, whereas no significant differences were observed for mMRC or 6-MWD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;1: Baseline characteristics of patients with ELVR (\u003c/strong\u003eAll data presented as mean \u0026plusmn; SD or median [Min. \u0026ndash; Max.], unless stated otherwise; superscript letters a and b indicate significance)\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSingle shot antibiotic prophylaxis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eProlonged (5/7-days) antibiotic prophylaxis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo antibiotic prophylaxis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients\u0026nbsp;\u003c/strong\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026nbsp;\u003c/strong\u003eyears\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e65.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026plusmn; 6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e65.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026plusmn; 7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026plusmn; 7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(54.8)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(55.9)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(49.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(45.2)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(44.1)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(51.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026alpha;\u003csub\u003e1\u003c/sub\u003e-Antitrypsin deficiency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(3.0)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(6.2)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCardiovascular disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(18.3)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(14.4)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePulmonary hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(11.5)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(2.9)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAtrial fibrillation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(4.8)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(5.9)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eArterial hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(49.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(43.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(45.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOsteoporosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDiabetes mellitus type II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePrevious history of lung cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLung cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eLung function at baseline\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFEV\u003csub\u003e1\u003c/sub\u003e % of pred\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.0\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[14.0-46.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28.0\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[13.0-78.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29.7\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[11.0-76.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFEV\u003csub\u003e1\u003c/sub\u003e (L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[0.3-2.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[0.3-1.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[0.4-2.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRV % of pred\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e221.0\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[57.0-386.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e242.5\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[72.9-500.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e243.0\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[75.4-627.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRV (L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.0\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[1.4-9.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.5\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[2.1-19.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.5\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[2.3-12.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDLCO % of pred\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31.0\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[3.0-67.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28.0\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[2.0-95.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31.0\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[1.4-84.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDLCO mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[0.2-5.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[0.2-62.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[0.1-9.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003epCO\u003csub\u003e2\u003c/sub\u003e mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38.0\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[5.-51.20]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41.0\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[5.3-96.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40.8\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[5.0-91.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6-MWD m\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e225.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[0.0-480.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e250.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[25.0-574.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e262.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[15.0-510.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCAT points\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26.5\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[10.0-40.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24.0\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[7.0-38.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26.0\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[6.0-40.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003emMRC points\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[1.0-4.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[0.0-4.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[1.0-4.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSGRQ points\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e67.3\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026plusmn; 10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e64.1\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026plusmn; 13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e67.6\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026plusmn; 13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations: FEV\u003c/em\u003e\u003cem\u003e₁\u003c/em\u003e\u003cem\u003e\u0026nbsp;= forced expiratory volume in 1 second; RV = residual volume; DLCO = diffusing capacity of the lung for carbon monoxide; pCO\u003c/em\u003e\u003cem\u003e₂\u003c/em\u003e\u003cem\u003e\u0026nbsp;= partial pressure of carbon dioxide; 6-MWD = 6-minute walking distance; CAT = COPD Assessment Test; mMRC = modified Medical Research Council Dyspnea Scale; SGRQ = St. George\u0026rsquo;s Respiratory Questionnaire.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMicrobiological characterization of lower airway colonization before ELVR\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcross all groups, the most frequently detected pathogens in pre-interventional cultures were Escherichia coli (12.0% in the single-shot group, 8.8% in the prolonged group, and 14.3% in the no-prophylaxis group) and Staphylococcus aureus (13.3%, 9.4%, and 3.6%, respectively) (table 2). Other commonly isolated organisms included Haemophilus influenzae (5.3% in the single-shot group, 7.0% in the prolonged group, none in the no-prophylaxis group), Klebsiella pneumoniae (6.7%, 4.7%, and 3.6%), and Pseudomonas aeruginosa (2.7%, 4.7%, and none). Streptococcus pneumoniae and \u0026beta;-hemolytic streptococci were found in up to 7.1% of patients, while Moraxella catarrhalis, Stenotrophomonas maltophilia, and Aspergillus fumigatus were rarely detected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Microbiological characterization of lower airway colonization before endoscopic lung volume reduction in patients treated with endobronchial valves\u0026nbsp;\u003c/strong\u003e\u003cem\u003e(\u0026szlig;-haemolytic streptococci including S. pyogenes, S. agalactiae, S. dysgalactiae)\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePathogens n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSingle shot antibiotic prophylaxis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eProlonged (5/7-days) antibiotic prophylaxis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNo antibiotic prophylaxis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eStaphylococcus aureus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (1.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003e\u0026beta;-hemolytic streptococci\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eHaemophilus influenzae\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12 (7.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eMoraxella catarrhalis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5 (6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eEscherichia coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9 (12.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15 (8.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eStenotrophomonas maltophilia\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eAspergillus fumigatus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (1.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eClinical outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical outcomes at three months were comparable across all groups receiving different peri-interventional antibiotic strategies (table 3). All three groups showed similar improvements in lung function, exercise capacity, and symptom burden, regardless of the antibiotic regimen applied.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Clinical Outcomes after 3-month follow-up based on type of peri-interventional antibiotic therapy.\u0026nbsp;\u003c/strong\u003eChanges over time were assessed by \u0026Delta; between baseline and 3-month follow-up.(All Data presented as mean \u0026plusmn; SD or median [Min. \u0026ndash; Max.], unless stated otherwise. * Missing values)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSingle shot antibiotic prophylaxis (n=104)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eProlonged (5/7-days) antibiotic prophylaxis\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=344)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo antibiotic prophylaxis (n=309)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026Delta;\u003cstrong\u003e\u0026nbsp;FEV1\u003c/strong\u003e % of pred\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[-13.0 \u0026ndash; 54.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[-43.0 \u0026ndash; 31.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;[-18.0 \u0026ndash; \u0026nbsp; 38.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026Delta;\u003cstrong\u003e\u0026nbsp;FEV1\u0026nbsp;\u003c/strong\u003e(L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[-1.2 \u0026ndash; 2.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[-0.4 \u0026ndash; 1.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;[-0.5 \u0026ndash; 1.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026Delta;\u003cstrong\u003e\u0026nbsp;RV %\u003c/strong\u003e of pred\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-31.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[-152.0 \u0026ndash; 145.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-27.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[-181.4 \u0026ndash; 162.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-32.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;[-342.0 \u0026ndash; 192.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026Delta;\u003cstrong\u003e\u0026nbsp;RV\u0026nbsp;\u003c/strong\u003e(L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[-4.5 \u0026ndash; 3.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[-4.1 \u0026ndash; 2.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;[-6.70 \u0026ndash; 3.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026Delta;\u003cstrong\u003e\u0026nbsp;DLCO %\u003c/strong\u003e of pred\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[-31.0 \u0026ndash; 46.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[-43.0 \u0026ndash; 49.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;[-21.0 \u0026ndash; 36.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026Delta;\u003cstrong\u003e\u0026nbsp;DLCO\u0026nbsp;\u003c/strong\u003e(mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[-3.0 \u0026ndash; 4.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[-4.0 \u0026ndash; 2.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;[-1.9 \u0026ndash; 5.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026Delta;\u003cstrong\u003e\u0026nbsp;pCO2\u003c/strong\u003e (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[-11.4 \u0026ndash; 9.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[40.4 \u0026ndash; 35.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;[52.6 \u0026ndash; 32.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026Delta;\u003cstrong\u003e\u0026nbsp;6MWD\u003c/strong\u003e m\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[-220.0 \u0026ndash; 161.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[-182.0- 330.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;[-223.0 - 260.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026Delta;\u003cstrong\u003e\u0026nbsp;CAT\u003c/strong\u003e points\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026plusmn; 6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026plusmn; 6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u0026plusmn; 6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026Delta;\u003cstrong\u003e\u0026nbsp;mMRC\u003c/strong\u003e points\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[-3 .0 \u0026ndash; 1.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[-3.0 \u0026ndash;4.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;[-3.0 \u0026ndash; 2.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026Delta;\u003cstrong\u003e\u0026nbsp;SGRQ\u003c/strong\u003e points\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[-39.5 \u0026ndash; 12.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[-57.4 \u0026ndash;18.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;[-52.4 \u0026ndash; 18.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations: FEV\u003c/em\u003e\u003cem\u003e₁\u003c/em\u003e\u003cem\u003e\u0026nbsp;= forced expiratory volume in 1 second; RV = residual volume; DLCO = diffusing capacity of the lung for carbon monoxide; pCO\u003c/em\u003e\u003cem\u003e₂\u003c/em\u003e\u003cem\u003e\u0026nbsp;= partial pressure of carbon dioxide; 6-MWD = 6-minute walking distance; CAT = COPD Assessment Test; mMRC = modified Medical Research Council Dyspnea Scale; SGRQ = St. George\u0026rsquo;s Respiratory Questionnaire.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdverse events\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdverse events within three months after ELVR are summarized in table 4. The incidence of pneumothorax, exacerbations, and pneumonia did not differ significantly between groups. Exacerbation and pneumonia rates were numerically highest in the single-shot group and lowest in the no-prophylaxis group, although these differences did not reach statistical significance (p = 0.12 and p = 0.09, respectively). Severe complications such as sepsis, hemoptysis, ICU admission, mechanical ventilation, and death were rare and occurred at similarly low frequencies across all groups. Length of hospital stay after ELVR was also comparable (see table S2 in the supplements).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Adverse events 3 months after endoscopic lung volume reduction in patients treated with endobronchial valves dependent on peri-interventional antibiotic therapy\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSingle shot antibiotic prophylaxis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eProlonged (5/7-days) antibiotic prophylaxis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo antibiotic prophylaxis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePneumothorax\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eExacerbations\u003c/strong\u003e n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePneumonia\u003c/strong\u003e n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSepsis\u003c/strong\u003e n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003en.a.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eHemoptysis\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003en.a.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eICU\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003en.a.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMechanical ventilation\u003c/strong\u003e n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003en.a.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDeath\u003c/strong\u003e n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003en.a.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations: ICU = intensive care unit.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAntibiotic-associated complications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAntibiotic-associated complications were rare across all groups and are summarized in table 7. No cases of anaphylaxis were reported. Minor adverse events, such as skin rash (0.3%) and diarrhea (0.6%), occurred exclusively in the prolonged prophylaxis group. No such events were observed in the single-shot group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7: Antibiotics-associated adverse events after endoscopic lung volume reduction in patients treated with endobronchial valves at Charit\u0026eacute;-Universit\u0026auml;tsmedizin, Berlin\u0026nbsp;\u003c/strong\u003e(*Vaginal mycosis)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSingle shot antibiotic prophylaxis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eProlonged (5/7-days) antibiotic prophylaxis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo antibiotic prophylaxis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSkin rash n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003en.a.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAnaphylaxis n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003en.a.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDiarrhea n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003en.a.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOther* n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003en.a.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003ePeri-interventional antibiotic prophylaxis, whether as a single shot or over a prolonged period, did not significantly reduce complication rates after ELVR. Clinical outcomes, including lung function, symptom burden, and quality of life, were comparable across groups. Pneumonia and AECOPD incidence was low in patients without prophylaxis but comparatively higher for pneumonia in those receiving a single-shot regimen, while prolonged prophylaxis showed similar rates to no prophylaxis. Antibiotic-related side effects and airway colonization occurred infrequently and without relevant differences.\u003c/p\u003e\n\u003cp\u003eELVR is a less invasive alternative to surgical lung volume reduction for advanced emphysema [1]. Randomized trials reported FEV₁\u0026nbsp;improvements of 100–150 mL and RV reductions of 400–700 mL within 3–6 months [3-7, 21-23]. In our study, median improvement after 3 months was +80 mL in FEV₁\u0026nbsp;and –640 mL RV, independent of antibiotic prophylaxis, suggesting that infection control is not the main driver of functional benefit. There are no standardized recommendations on peri-interventional antibiotics in ELVR. In the first pilot study for ELVR, the VENT trial, prophylactic antibiotics were administered shortly before and up to 7 days after valve implantation [7]. The rationale for prolonged antibiotic therapy is based on the assumption that immobilization and the presence of foreign material may promote secretion retention and microbial colonization. Indeed, biofilm formation has been demonstrated on explanted endobronchial valves, supporting the concept that microbial communities can persist on device surfaces [24]. Subsequent large, randomized ELVR studies employed different prophylactic regimens. For instance, the IMPACT study used prolonged antibiotic therapy for 5 to 7 days [4], whereas the REACH trial administered only a single-dose antibiotic therapy during the bronchoscopy procedure\u0026nbsp;[10]. Despite these varied approaches, no systematic investigation has been conducted to determine the effect of prophylactic antibiotic administration during ELVR. To our knowledge, our study is the first to evaluate whether different regimens of prophylactic antibiotics impact the outcomes after ELVR.\u003c/p\u003e\n\u003cp\u003eDespite its minimally invasive nature, ELVR is associated with several potential complications that require careful consideration and management. One of the potential adverse events are exacerbations and pneumonia following EBV implantation, which can lead to EBV removal [8]. In our study, adverse event rates at 3 months ranged from 3.2–7.7% for pneumonia and 5.5–11.5% for AECOPD. We found that a single dose of antibiotics during ELVR may be as effective as prolonged peri-interventional antibiotic therapy. Moreover, there was no significant difference in adverse event rates between patients who received no prophylaxis and those who received antibiotic prophylaxis during ELVR. These findings suggest that if peri-interventional antibiotics are used during ELVR, a single dose is sufficient, and in some cases, they may not be necessary at all. Other reports have suggested benefit: Abia-Trujillo et al. found fewer exacerbations with prophylaxis [25], but their non-prophylaxis group was very small (n = 26) compared with ours (n = 309). Our larger data set therefore provides a more robust estimate of the effect of peri-interventional antibiotics.\u003c/p\u003e\n\u003cp\u003eChronic airway colonization is common in ELVR patients [11]. Long-term follow-up after EBV implantation showed increased prevalence of Staphylococcus aureus, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Moraxella catarrhalis, and anaerobes [26]. However, colonization was not directly associated with poorer function. Distinguishing colonization from infection remains challenging, and outcomes are influenced by host immunity and comorbidity burden.\u003c/p\u003e\n\u003cp\u003eThis study has several limitations. The observational design precludes causal inference, and the absence of randomization may introduce selection bias. In particular, the choice of peri-interventional antibiotic strategy was not standardized but depended on individual clinical judgement and center-specific practice, rather than on uniform criteria. As a result, systematic differences between groups may partly reflect center preferences rather than underlying patient characteristics. Registry-based data may incompletely capture comorbidities, baseline parameters, or adverse events. Follow-up documentation was less complete than baseline, limiting the ability to reliably assess long-term outcomes. Event rates for pneumonia and AECOPD were low, and some exacerbations were only captured when treated in hospital. Due to missing data and the small number of outcome events, robust multivariable regression or time-to-event analyses were not feasible. Center-level differences, including patient preparation, mobilization protocols, inhalation therapy, and physiotherapy, may have influenced outcomes independently of antibiotic use. Despite these limitations, the study has notable strengths. It represents the largest multicenter cohort to date evaluating peri-interventional antibiotic strategies in ELVR. The LE-Registry includes more than 700 well-characterized patients, providing comprehensive real-world data and enabling systematic assessment of outcomes and adverse events across different clinical practices.\u003c/p\u003e\n\u003cp\u003eAlthough residual confounding cannot be ruled out, our results indicate that peri-interventional antibiotic prophylaxis, whether single-shot or prolonged, does not improve outcomes or reduce adverse events in routine ELVR. In line with antimicrobial stewardship, routine use should be questioned, as it adds side effects and fosters resistance without measurable benefit. Antibiotic treatment may still be considered in selected patients, such as those with suspected infection after EBV implantation or with chronic colonization, where a short targeted course or long-term modulatory therapy (e.g. azithromycin) could help manage adverse events. Such strategies should remain individualized rather than routine.\u003c/p\u003e\n\u003cp\u003eTo strengthen the evidence base, randomized controlled trials with larger cohorts and extended follow-up are needed. Future studies should better characterize exacerbations and infectious events, examine microbiological dynamics such as valve colonization and biofilm formation, and integrate measures of symptom burden and patient-reported outcomes.\u003c/p\u003e\n\u003cp\u003eThis multicenter study found no evidence that peri-interventional antibiotic prophylaxis reduces adverse events or improves outcomes after ELVR in severe COPD. Improvements in lung function, exercise capacity, and quality of life were observed across all groups, regardless of antibiotic use. Pneumonia and exacerbations remained infrequent and were not reduced by prophylaxis. Routine administration of antibiotics in this setting cannot therefore be recommended.\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAECOPD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcute Exacerbation of Chronic Obstructive Pulmonary Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCAT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCOPD Assessment Test\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCOPD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChronic Obstructive Pulmonary Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDLCO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDiffusing Capacity of the Lung for Carbon Monoxide\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEBV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEndobronchial Valve\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eELVR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEndoscopic Lung Volume Reduction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFEV₁\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eForced Expiratory Volume in 1 Second\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntensive Care Unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRegistry\u0026ndash;German Lung Emphysema Registry\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMIQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMicrobiological\u0026ndash;Infectious Quality Standards\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003emMRC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eModified Medical Research Council Dyspnea Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eResidual Volume\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSGRQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSt. George\u0026rsquo;s Respiratory Questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e6MWD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSix\u0026ndash;Minute Walking Distance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: E.P., R-H.H.; Data curation: E.P., H.D., T.S.; J.S. and R-H.H.; Data collection: E.P., H.D., T.S., J.S., K.D., S.A., S.E., B.S., W.G., N.D., C.G., J.F., A.H., B.S., S.E., R.E., C.G., C.H., U.S., A.F., S.K., P.S..; Formal analysis: E.P., H.D., T.S.; J.S. and R-H.H.; Funding acquisition: R-H.H. and M.W.; Methodology: E.P., H.D., D.S. and R-H.H.; Visualization: E.P., D.S. and H.D.; Writing - original draft: E.P. and R-H.H. ; Writing - review \u0026amp; editing: E.P., H.D., T.S., J.S., K.D., S.A., S.E., B.S., W.G., N.D., C.G., J.F., A.H., B.S., S.E., R.E., C.G., C.H., U.S., A.F., S.K., P.S., L.E.S.; Supervision: R-H.H. and M.W.. All authors have approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eE.P.:\u003c/strong\u003e No conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH.D.:\u0026nbsp;\u003c/strong\u003eNo conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eT.S.:\u003c/strong\u003e No conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJ.S.:\u003c/strong\u003e received payment or support for attending congresses from PulmonX and Boehringer Ingelheim, serves on the scientific advisory board of LE-Registry.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eK.D.:\u003c/strong\u003e received payment or honoraria for lectures and consulting, from bess, Lys Medical, Olympus, PulmonX, Boston Scientific, Boehringer Ingelheim, Broncus Medical, Erbe, Storz, Fujifilm, Intuitive, payments to the institution from Boston Scientific, Boehringer Ingelheim, Broncus Medical, Erbe, Lys Medical, Olympus, PulmonX, Storz, participates on the societies: DGP, and World Association for Bronchology and Interventional Pneumology.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eS.A.:\u003c/strong\u003e received payment or honoraria for lectures and consulting, from Sanofi, Boehringer Ingelheim, Novartis, AstraZeneca, GSK, Chiesi, Merini, support for attending congresses from Boehringer Ingelheim, speaker of the Section “Tabakentwöhnung” at DGP and board member of the ABNR.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eS.E.:\u003c/strong\u003e received payment or honoraria for lectures from PulmonX.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eB.S.:\u003c/strong\u003e No conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eW.G.:\u0026nbsp;\u003c/strong\u003ereceived payment or honoraria for lectures\u0026nbsp;from Astra Zeneca, Boehringer Ingelheim, Bristol Myers Sqibb, PulmonX, Springer Medicine\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eN.D.:\u003c/strong\u003e No conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eC.G.:\u0026nbsp;\u003c/strong\u003eNo conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJ.F.:\u0026nbsp;\u003c/strong\u003eNo conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA.H.:\u003c/strong\u003e No conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eB.S.:\u003c/strong\u003e No conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eS.E.:\u003c/strong\u003e serves on the scientific advisory board of LE-Registry.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eR.E.:\u003c/strong\u003e received payment or honoraria for lectures\u0026nbsp;from AstraZeneca, CSL Behring, Olympus, Pulmonx, Pentax, serves on the scientific advisory board of LE-Registry.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eC.G.:\u003c/strong\u003e No conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eC.H.:\u003c/strong\u003e No conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eU.S.:\u0026nbsp;\u003c/strong\u003eNo conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA.F.:\u003c/strong\u003e No conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eS.K.:\u003c/strong\u003e No conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eP.S.:\u003c/strong\u003e No conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eD.S.:\u003c/strong\u003e No conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eL.E.S.:\u0026nbsp;\u003c/strong\u003eNo conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eM.W.:\u003c/strong\u003e received grants from Bundesministerium für Forschung, Technologie und Raumfahrt (BMFTR; Federal Ministry of Research, Technology and Space), Deutsche Forschungsgemeinschaft (DFG; German Research Foundation), Gemeinsamer Bundesausschuss (G-BA; The Federal Joint Committee), Bundesministerium für Gesundheit (BMG; Federal Ministry of Health), received payment or honoraria for lectures and consulting from Biotest, Pantherna, Aptarion, Biotest, Pantherna, Aptarion, Astra Zeneca, Chiesi, Insmed, Gilead, Pfizer, Boehringer Personal Fees\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eR-H.H.:\u003c/strong\u003e received study fee (Convert) from Pulmonx; received payment or honoraria for lectures from Berlin Chemie, Astra, Chiesi and Pulmonx; an\u0026nbsp;received payment or support for attending congresses Medtronic.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported in part by grants from CAPNETZ Stiftung and LE-Registry. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all patients for their participation in this study. We also gratefully acknowledge all members of the LE-Registry and Monika Rummenholl (LE-Registry, Berlin, Germany) as well as Grit Barten-Neiner (CAPNETZ Lungenstiftung, Hannover, Germany), for their valuable support.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSome of the data from the study have been presented by the author Eva Pappe as poster at the congress of the German respiratory society (DGP) in Wiesbaden 2024 and European Respiratory Society (ERS) Congress in Vienna 2024.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData can be made available on request to the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHerth FJF, et al. Endoscopic Lung Volume Reduction: An Expert Panel Recommendation - Update 2019. Respiration. 2019;97(6):548\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCriner GJ, et al. A Multicenter Randomized Controlled Trial of Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema (LIBERATE). Am J Respir Crit Care Med. 2018;198(9):1151\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKemp SV, et al. A Multicenter Randomized Controlled Trial of Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema (TRANSFORM). Am J Respir Crit Care Med. 2017;196(12):1535\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eValipour A, et al. Endobronchial Valve Therapy in Patients with Homogeneous Emphysema. Results from the IMPACT Study. Am J Respir Crit Care Med. 2016;194(9):1073\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKlooster K, et al. Endobronchial Valves for Emphysema without Interlobar Collateral Ventilation. N Engl J Med. 2015;373(24):2325\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavey C, et al. Bronchoscopic lung volume reduction with endobronchial valves for patients with heterogeneous emphysema and intact interlobar fissures (the BeLieVeR-HIFi study): a randomised controlled trial. Lancet. 2015;386(9998):1066\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSciurba FC, et al. A randomized study of endobronchial valves for advanced emphysema. N Engl J Med. 2010;363(13):1233\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eH\u0026uuml;bner RH, et al. Endoscopic Lung Volume Reduction: Can Endobronchial Valves Be Safely Removed? Respiration. 2020;99(5):459\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStrange C, et al. Design of the Endobronchial Valve for Emphysema Palliation Trial (VENT): a non-surgical method of lung volume reduction. BMC Pulm Med. 2007;7(1):10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi S, et al. The REACH Trial: A Randomized Controlled Trial Assessing the Safety and Effectiveness of the Spiration\u0026reg; Valve System in the Treatment of Severe Emphysema. Respiration. 2019;97(5):416\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrudzinski FC, et al. Microbiological airway colonization in COPD patients with severe emphysema undergoing endoscopic lung volume reduction. Int J Chron Obstruct Pulmon Dis. 2018;13:29\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u003cem\u003eS3-Leitlinie Perioperative und Periinterventionelle Antibiotikaprophylaxe \u0026ndash; Aktualisierung\u003c/em\u003e 2024. Langversion, 5.0. 2024. AWMF Registernummer: 067/009, DOI: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://register.awmf.org/de/leitlinien/detail/067-009\u003c/span\u003e\u003cspan address=\"https://register.awmf.org/de/leitlinien/detail/067-009\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarris PA, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inf. 2019;95:103208.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSgarbossa T, et al. Comparison of Efficacy and Safety of Different Types of One-Way Valves in Endoscopic Lung Volume Reduction in Patients with Severe Lung Emphysema. Respiration. 2025;104(4):281\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaccomanno J et al. Clinical improvements after endoscopic lung volume reduction with valves in patients with advanced emphysema and a 6-min walk test\u0026thinsp;\u0026le;\u0026thinsp;140 m at baseline. ERJ Open Res, 2025. 11(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSgarbossa T et al. Assessment of efficacy and safety of endoscopic lung volume reduction with one-way valves in patients with a very low FEV(1). ERJ Open Res, 2023. 9(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePappe E, et al. Impact of Coronavirus Disease 2019 on Hospital Admissions, Health Status, and Behavioral Changes of Patients with COPD. Chronic Obstr Pulm Dis. 2023;10(3):211\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLenga P, et al. Endoscopic Lung Volume Reduction with One-Way Valves in Patients with Severe Chronic Obstructive Pulmonary Disease with Hypercapnia. Respiration. 2022;101(9):823\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLenga P et al. Endoscopic lung volume reduction with endobronchial valves in very low D (LCO) patients: results from the German Registry - Lungenemphysemregister e.V. ERJ Open Res, 2021. 7(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u003cem\u003eMikrobiologisch-infektiologische Qualit\u0026auml;tsstandards: MiQ ; Qualit\u0026auml;tsstandards in der mikrobiologisch-infektiologischen Diagnostik / Expertengremium Mikrobiologische-Infektiologische Qualit\u0026auml;tsstandards (MiQ) ; Qualit\u0026auml;tssicherungskommission der Deutschen Gesellschaft f\u0026uuml;r Hygiene und Mikrobiologie (DGHM). Im Auftr. der Deutschen Gesellschaft f\u0026uuml;r Hygiene und Mikrobiologie (DGHM)\u003c/em\u003e. M\u0026uuml;nchen: Elsevier, Urban \u0026amp; Fischer.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNada KM, Nishi S. Endoscopic Lung Volume Reduction: Review of the EMPROVE and LIBERATE trials. Mayo Clin Proc Innov Qual Outcomes. 2021;5(1):177\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCriner GJ, et al. Improving lung function in severe heterogenous emphysema with the spiration valve system (EMPROVE). A multicenter, open-label randomized controlled clinical trial. Am J Respir Crit Care Med. 2019;200(11):1354\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCriner GJ, et al. A multicenter randomized controlled trial of zephyr endobronchial valve treatment in heterogeneous emphysema (LIBERATE). Am J Respir Crit Care Med. 2018;198(9):1151\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePappe E, et al. Biofilm infections of endobronchial valves in COPD patients after endoscopic lung volume reduction: a pilot study with FISHseq. Sci Rep. 2024;14(1):23078.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbia-Trujillo D, et al. Prevention of acute exacerbation of chronic obstructive pulmonary disease after bronchoscopic lung volume reduction with endobronchial valves. Clin Respir J. 2022;16(1):43\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarmand N, et al. New bacterial growth in bronchial secretions after bronchoscopic valve implantation. Int J Chron Obstruct Pulmon Dis. 2018;13:565\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"infection","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infe","sideBox":"Learn more about [Infection](http://link.springer.com/journal/15010)","snPcode":"15010","submissionUrl":"https://submission.nature.com/new-submission/15010/3","title":"Infection","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8280597/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8280597/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEndoscopic 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eComparative 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\u0026ndash;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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 900 patients undergoing ELVR, 104 received single-dose prophylaxis, 344 prolonged 5\u0026ndash;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\u0026thinsp;=\u0026thinsp;0.12). Pneumonia was observed in 7.7% (8/104), 3.2% (11/344), and 3.2% (10/309), respectively (p\u0026thinsp;=\u0026thinsp;0.087). Antibiotic-related adverse events were infrequent and mild, occurring only in the prolonged prophylaxis group.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePeri-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.\u003c/p\u003e","manuscriptTitle":"Peri-interventional antibiotic prophylaxis in endoscopic valve implantation for lung volume reduction in COPD patients: results from a German multicenter observational cohort","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 09:27:14","doi":"10.21203/rs.3.rs-8280597/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-15T10:48:32+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-14T16:33:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52828405438247567645985376762320686281","date":"2026-01-04T07:59:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-30T11:10:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"89318356391522249726223370357665020255","date":"2025-12-15T12:15:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-15T10:30:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-05T09:27:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-05T08:14:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"Infection","date":"2025-12-04T14:43:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"infection","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infe","sideBox":"Learn more about [Infection](http://link.springer.com/journal/15010)","snPcode":"15010","submissionUrl":"https://submission.nature.com/new-submission/15010/3","title":"Infection","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"d511abc0-cc72-4772-b927-d618a2753048","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T16:08:53+00:00","versionOfRecord":{"articleIdentity":"rs-8280597","link":"https://doi.org/10.1007/s15010-026-02742-w","journal":{"identity":"infection","isVorOnly":false,"title":"Infection"},"publishedOn":"2026-02-13 15:59:32","publishedOnDateReadable":"February 13th, 2026"},"versionCreatedAt":"2025-12-22 09:27:14","video":"","vorDoi":"10.1007/s15010-026-02742-w","vorDoiUrl":"https://doi.org/10.1007/s15010-026-02742-w","workflowStages":[]},"version":"v1","identity":"rs-8280597","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8280597","identity":"rs-8280597","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}