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Letter to the Editor
Lung Volume Reduction Coil Treatment: Is There an Indication for Antibiotic Prophylaxis?
Reducción de volumen pulmonar mediante espirales: ¿está indicada la profilaxis con antibióticos?
Alessio Casutta,b,
Corresponding author
alessio.casutt@unil.ch

Corresponding author.
, Angela Koutsokeraa, Alban Lovisa
a Respiratory Medicine Department, University Hospital of Lausanne, CHUV, Lausana, Switzerland
b Internal Medicine Department, Hospital Civico of Lugano, Lugano, Switzerland
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In their article&#44; Deslee et al&#46; show that the use of metal coils for lung volume reduction &#40;LVR&#41; is feasible&#44; safe&#44; and effective&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> They report that 5&#46;2&#37; of patients developed pneumonia within 30 days after treatment&#44; even after patients with clinically significant recurrent respiratory infections were excluded&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The indications for LVR using coils have already been characterized&#44;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">2&#8211;4</span></a> but the contraindications and risk factors for complications&#44; such as post-operative pneumonia&#44; still have to be determined&#46; This is particularly important for patients with limited respiratory reserve&#44; in whom infectious complications are potentially fatal&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We report the case of a 69-year-old woman with phase IV chronic obstructive pulmonary disease &#40;FEV<span class="elsevierStyleInf">1</span> 24&#37; predicted and residual volume 244&#37; predicted&#41;&#44; severe dyspnea and 1&#8211;2 exacerbations&#47;year&#46; She underwent LVR surgery to the right upper lobe and received maximum intensity medical treatment&#44; but subsequently relapsed with dyspnea and functional limitation&#44; without pulmonary hypertension&#46; Imaging studies showed predominantly apical heterogeneous emphysema&#46; Repeat LVR surgery was ruled out in view of the high risk of complications&#46; Three months before the coil intervention&#44; she had been diagnosed with onset of an exacerbation caused by <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#46; This was treated with meropenem&#44; resulting in clinical improvement and a negative sputum culture&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Nine coils were placed in the left upper lobe with endoscopic LVR&#44; with no immediate complications&#46; There were no secretions&#44; bronchial aspirate culture was sterile&#44; and no antibiotic prophylaxis was administered&#46; Two weeks later&#44; the patient developed fever&#44; cough&#44; and worsening dyspnea&#46; Clinical laboratory tests showed raised neutrophils and C-reactive protein levels&#44; and chest X-ray revealed new alveolar infiltrations in the lower left lobe&#44; so piperacillin and tazobactam were administered while waiting for sputum culture results&#46; The patient suffered septic shock&#44; requiring mechanical ventilation&#44; and the alveolar infiltration was seen to have extended&#46; Sputum cultures were positive for <span class="elsevierStyleItalic">P&#46; aeruginosa</span> and <span class="elsevierStyleItalic">Aspergillus fumigatus</span>&#44; so we decided to prescribe meropenem and voriconazole&#46; The diagnosis was redefined as septic shock caused by <span class="elsevierStyleItalic">P&#46; aeruginosa</span> pneumonia and probable semi-invasive pulmonary aspergillosis&#46; Clinical progress was good and the patient was discharged from hospital after 2 months&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">This case&#44; like those reported by Deslee et al&#46;&#44; illustrates that the use of coils for performing LVR may be associated with severe pneumonia&#46; Specialists should be aware of this risk and evaluate the administration of prophylactic antibiotics&#44; at least in the subgroup of patients who have had previous colonization or infections with pathogenic bacteria&#46; The gradual increase in the use of coils for LVR may lead in the future to a better definition of the risk&#8211;benefit ratio of the intervention&#44; providing a better understanding of the infectious complications&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">No funding was required&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors state that they had no conflict of interests&#46;</p></span></span>"
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Article information
ISSN: 15792129
Original language: English
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