Evaluation of outcomes in dogs treated for pyothorax: 46 cases (1983–2001)

Abstract

OBJECTIVE-To determine the effect of treatment approach on outcome and the appropriateness of initial empirical antimicrobial treatment in dogs with pyothorax. DESIGN-Retrospective case series. ANIMALS-46 dogs with pyothorax confirmed by either (n = 15) or both (31) of the following: intracellular bacteria in pleural fluid or tissue (41) and bacteria recovered via culture of pleural fluid (36). PROCEDURES-Medical records of dogs treated for pyothorax from 1983 through 2001 were reviewed. Data on signalment, history, clinical signs, and treatment and results of diagnostic imaging and cytologic and microbiological evaluations were obtained. Follow-up was performed via reexamination (n = 15) and contact with referring veterinarians (26) and owners (24). RESULTS-46 dogs were treated with at least 1 antimicrobial and thoracocentesis (n = 7; noninvasive group), a thoracostomy tube (26; invasive group) with or without pleural lavage and heparin, or a thoracotomy (13; surgical group) and thoracostomy tube with or without pleural lavage and heparin. Pyothorax recurred in 7 dogs, and 5 of the 7 died or were euthanatized. In the respective groups, the short-term survival rate was 29%, 77%, and 92% and the long-term survival rate was 29%, 71%, and 70%. Pleural lavage and heparin treatment increased the likelihood of short- and long-term survival. Results of antimicrobial susceptibility testing suggested empirical antimicrobial selection was associated with a 35% risk of inefficacy. CONCLUSIONS AND CLINICAL RELEVANCE-In the dogs with pyothorax in this study, favorable treatment effects were achieved with surgery (for short-term survival) and pleural lavage and heparin treatment (for short- and long-term survival). Findings failed to support the hypothesis that invasive (surgical) versus noninvasive treatment of pyothorax in dogs leads to a better long-term outcome.

Mediastinectomy for management of chronic pyogranulomatous pleural disease in dogs

“…This breed distribution is similar to that reported in studies of dogs with pyothorax in which young working breeds also featured prominently (Demetriou and others 2002, Rooney and Monnet 2002, Johnson and Martin 2007, Boothe and others 2010). All patients were found to have pleural changes on diagnostic imaging similar to those described in a recent study of pyothorax in dogs (Swinbourne and others 2011).…”

“…Both, medical and surgical management strategies have been described for the treatment of pyothorax (Demetriou and others 2002, Rooney and Monnet 2002, Johnson and Martin 2007, Boothe and others 2010). Boothe and others reported favourable treatment effects with surgery for short-term survival in dogs with pyothorax, but failed to demonstrate that invasive (surgical) versus non-invasive treatment of pyothorax in dogs lead to a better long-term outcome (Boothe and others 2010). Boothe and others did, however, demonstrate that pleural lavage and heparin treatment significantly improved both short-term and long-term survival in dogs with pyothorax.…”

“…Rooney and Monnet reported greater success in selected cases following surgical management, with 85 per cent of dogs disease-free after six months as compared with only 32 per cent of the dogs treated medically (Rooney and Monnet 2002). Boothe and others reported recurrence of pyothorax in less than 20 per cent of dogs; of these dogs, four had previously undergone surgical exploration of the thorax, however, the extent of surgery was not specified (Boothe and others 2010). The recurrence of pyothorax in Boothe and others' study was associated with a high mortality rate (five out of seven dogs were euthanased).…”

“…Even if there is no single breed predilection, hunting and working-type dogs are reported to be over-represented (Demetriou and others 2002, Rooney and Monnet 2002, Scott and Macintire 2003b, Johnson and Martin 2007). Surgical management has been recommended for the treatment of selected patients with pyothorax (Demetriou and others 2002, Rooney and Monnet 2002, Boothe and others 2010). In Boothe and others' study, surgery was associated with a higher short-term survival rate, but they failed to demonstrate that surgery resulted in a better long-term outcome compared to non-invasive treatments for pyothorax (Boothe and others 2010).…”

“…Surgical management has been recommended for the treatment of selected patients with pyothorax (Demetriou and others 2002, Rooney and Monnet 2002, Boothe and others 2010). In Boothe and others' study, surgery was associated with a higher short-term survival rate, but they failed to demonstrate that surgery resulted in a better long-term outcome compared to non-invasive treatments for pyothorax (Boothe and others 2010). Rooney and Monnet, however, reported better outcomes with surgery compared to medical therapy, with 85 per cent of patients disease-free six months after surgery (Rooney and Monnet 2002).…”