SPONTANEOUS BACTERIAL EMPYEMA IN CIRRHOTIC-PATIENTS - A PROSPECTIVE-STUDY

Spontaneous bacterial empyema (SEEM) is an infection of a preexisting hydrothorax in cirrhotic patients and has seldom been reported, To det ermine its incidence and primary characteristics, all cirrhotic patien ts with pleural effusion underwent thoracentesis at our hospital eithe r on admission or when an infection was suspected. Pleural fluid (PF) study included biochemical analysis, polymorphonuclear (PMN) leukocyte count, and culture by two methods: conventional and modified (inocula tion of 10 mit of PF into a blood culture bottle at the bedside), SBEM was defined according to previously reported criteria: PF culture pos itive or PMN count greater than 500 cells/mu L, and exclusion of para- pneumonic effusions. Sixteen of the 120 (13%) cirrhotic patients admit ted with hydrothorax had 24 episodes of SBEM. In 10 of the 24 episodes (43%), SBEM was not associated with spontaneous bacterial peritonitis (SBP), PF culture was positive by the conventional method in 8 episod es (33%) and by the modified method (blood culture inoculation) in 18 (75%) (P = .004, McNemar), The microorganisms identified in PF were Es cherichia coli in 8 episodes, Streptococcus species in 4, Enterococcus species in 3, Klebsiella pneumoniae in 2, and Pseudomonas stutzeri in 1. All episodes were treated with antibiotics without inserting a che st tube in any case, Mortality during treatment was 20%. We conclude t hat SBEM is a common complication of cirrhotic patients with hydrothor ax. Almost half of the episodes were not associated with SBP; thus, th oracentesis should be performed in patients with cirrhosis, pleural ef fusion, and suspected infection. Culture of PF should be performed by inoculating 10 mL into a blood culture bottle at the bedside.