Airway bacterial colonization and serum C-reactive protein are associated with chronic obstructive pulmonary disease exacerbation following bronchoscopic lung volume reduction.

Abstract

INTRODUCTION:

Stable chronic obstructive pulmonary disease (COPD) patients often have lower airway bacterial colonization (ABC) which may modulate exacerbation frequency. Data regarding the association between ABC and post-procedural COPD exacerbations following bronchoscopic lung volume reduction (BLVR) are scant.

OBJECTIVES:

Our aim was to explore the correlation among ABC, serum C-reactive protein (CRP) level and the risk of COPD exacerbation within a month following BLVR.

METHODS:

Pre-procedure bronchoalveolar lavage (BAL) quantitative bacterial cultures and serum levels of CRP were evaluated in severe COPD patients (N = 70, mean FEV1  = 34.6%) before BLVR by polymeric lung sealant.

RESULTS:

Colonization with potential pathogenic microorganism (PPM) was observed in 40 (57.1%) patients. Out of 28 patients (40%) who had COPD exacerbation within 30 days of BLVR, 23 (82.1%) had PPM in BAL culture compared with only 14 (33.3%) out of 42 patients who had uneventful procedure (P = 0.0027). Serum CRP level was significantly higher in patients with exacerbation compared with those with no exacerbation (mean 47.8 ± 66.0 mg/L vs 13.05 ± 27.7 mg/L, respectively, P = 0.0063). The combination of CRP level above 3.12 mg/L and PPM growth in BAL was observed in 89.2% of patients with exacerbation compared with only 52.3% of patients without exacerbation (P = 0.0031).

CONCLUSIONS:

ABC is common in severe COPD patients undergoing BLVR, and along with elevated CRP level both are associated with high risk of immediate post-procedural COPD exacerbation. These patients should be identified, carefully observed and possibly benefit from prophylactic microbiologically directed antibiotic treatment.

• Authors: Oren Fruchter, Dror Rosengarten, Elad Goldberg, Haim Ben-Zvi, Ruth Tor, Mordechai R Kramer
• Journal: The clinical respiratory journal (Clin Respir J) Vol. 10 Issue 2 Pg. 239-45 (Mar 2016) ISSN: 1752-699X [Electronic] England
• PMID: 25196428 (Publication Type: Journal Article)
• Copyright: © 2014 John Wiley & Sons Ltd.

Chemical References

• C-Reactive Protein

Topics

• Aged
• Bronchoalveolar Lavage Fluid (microbiology)
• Bronchoscopy (adverse effects, methods)
• C-Reactive Protein (metabolism)
• Disease Progression
• Female
• Humans
• Male
• Middle Aged
• Pneumonectomy (adverse effects, methods)
• Postoperative Complications (blood, etiology, microbiology)
• Pulmonary Disease, Chronic Obstructive (blood, microbiology, surgery)
• Respiratory Tract Infections (blood, etiology, microbiology)
• Retrospective Studies
• Risk Factors