Using current first-line therapy, patients with cirrhosis and acute peptic ulcer bleeding have a similar survival than those with variceal bleeding. The risk of further bleeding is higher in patients with variceal hemorrhage. However, few patients in both groups died from uncontrolled bleeding, rather the cause of death was usually related to liver failure or comorbidities. (Hepatology 2018;67:1458-1471).

Whereas spontaneous bacterial peritonitis (SBP) isSpontaneous 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 biochemi-with 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 inIn 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 cirr...

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