Whereas spontaneous bacterial peritonitis (SBP) is
Spontaneous bacterial empyema (SBEM) is an infection of a preexisting hydrothorax in cirrhotic patients a well-known entity with a reported incidence between and has seldom been reported. To determine its inci-15% and 20% in hospitalized cirrhotic patients with dence and primary characteristics, all cirrhotic patients ascites, 1-3 spontaneous bacterial empyema (SBEM)with pleural effusion underwent thoracentesis at our the infection of a preexisting hydrothorax-has seldom hospital either on admission or when an infection was been reported. 4 Because 5% to 10% of cirrhotic patients suspected. Pleural fluid (PF) study included biochemiwith ascites have an associated hydrothorax, 5,6 SBEM cal analysis, polymorphonuclear (PMN) leukocyte count, could be expected to appear in 1% to 2% of hospitalized and culture by two methods: conventional and modified cirrhotic patients with ascites. Apart from case reports, (inoculation of 10 mL of PF into a blood culture bottle at only two retrospective series including a total of 15 the bedside). SBEM was defined according to previously episodes have been published. 4,7 The aim of this study reported criteria: PF culture positive or PMN count was to investigate incidence, bacteriology, and clinical greater than 500 cells/mL, and exclusion of parapneumonic effusions. Sixteen of the 120 (13%) cirrhotic characteristics of SBEM and to confirm the data obpatients admitted with hydrothorax had 24 episodes of tained in our previous retrospective study. 4 SBEM. In 10 of the 24 episodes (43%), SBEM was not associated with spontaneous bacterial peritonitis (SBP).
PATIENTS AND METHODS PF culture was positive by the conventional method in
In a university-based reference hospital, from September 8 episodes (33%) and by the modified method (blood cul-1988 to December 1992, a thoracentesis was performed on ture inoculation) in 18 (75%) (P Å .004, McNemar). The all cirrhotic patients with pleural effusion on admission (or microorganisms identified in PF were Escherichia coli when the effusion was detected for the first time during hosin 8 episodes, Streptococcus species in 4, Enterococcus pitalization) or when an infection was suspected during adspecies in 3, Klebsiella pneumoniae in 2, and Pseudomomission because of fever, abdominal or chest pain, hepatic nas stutzeri in 1. All episodes were treated with antibiotencephalopathy, or shock. If ascites was present, a paracenteics without inserting a chest tube in any case. Mortality sis also was performed at the same time. Pleural fluid (PF) during treatment was 20%. We conclude that SBEM is a study included bacteriologic study, cytology, polymorphonucommon complication of cirrhotic patients with hydroclear (PMN) leukocyte count, and glucose, protein, amylase, thorax. Almost half of the episodes were not associated lactic dehydrogenase, and adenosine deaminase determinawith SBP; thus, thoracentesis should be performed in tions. pH also was performed if an infection was suspected.
patients with cirrhosis, pleural effusion, and suspected
The bacteriologic study was performed using two different infection. Culture of PF should be performed by inocumethods: conventional and modified. 8 In the conventional lating 10 mL into a blood culture bottle at the bedside.
method, a sample of PF was collected in an empty sterile (HEPATOLOGY 1996;23:719-723.)
container and sent to the Clinical Microbiology Laboratory.
Ten milliliters was centrifuged at 3,000 rpm for 20 minutes. The sediment was cultured on enriched chocolate agar, blood agar, MacConkey's agar, and thioglycolate broth. The cul-Abbreviations: SBP, spontaneous bacterial peritonitis; SBEM, spontaneous tures were incubated at 35ЊC in a CO 2 (10%-15%) incubator bacterial empyema; PF, pleural fluid; PMN, polymorphonuclear; AF, ascitic for 48 hours. Both plates and broth were examined at 24 and fluid; OLT, orthotopic liver transplantation.
48 hours for visible growth. In the modified method, 10 mL From the Gastroenterology Service, Hospital de Bellvitge, 08907 L'Hospitaof PF was inoculated into a 70-mL ''Liquoid'' Blood Culture