title: Airway bacterial colonization and serum C-reactive protein are associated with chronic obstructive pulmonary disease exacerbation following bronchoscopic lung volume reduction.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.affiliation: Pulmonary Institute, Rabin Medical Center, Petah Tikva, Israel.|The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Oren
authors.initials: O
authors.lastname: Fruchter
authors.affiliation: Pulmonary Institute, Rabin Medical Center, Petah Tikva, Israel.|The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Dror
authors.initials: D
authors.lastname: Rosengarten
authors.affiliation: The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.|Internal Medicine, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Elad
authors.initials: E
authors.lastname: Goldberg
authors.affiliation: The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.|Department of Medical Laboratory, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Haim
authors.initials: H
authors.lastname: Ben-Zvi
authors.affiliation: The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.|Department of Medical Laboratory, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Ruth
authors.initials: R
authors.lastname: Tor
authors.affiliation: Pulmonary Institute, Rabin Medical Center, Petah Tikva, Israel.|The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Mordechai R
authors.initials: MR
authors.lastname: Kramer
mesh_terms: D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods*; D002097:C-Reactive Protein / Q000378:metabolism*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000382:microbiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000382:microbiology / Q000601:surgery*; D012141:Respiratory Tract Infections / Q000097:blood / Q000209:etiology* / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D002097:C-Reactive Protein
keywords: COPD; bronchial colonization; exacerbation; lung volume reduction; postoperative respiratory infection; risk factors