Coexistence of Spontaneous Bacterial Peritonitis and Spontaneous Bacterial Empyema Carries Poor Prognosis in Cirrhotic Patients with Ascites and Hydrothorax

Mohamed, Wagdy Abd El-Fattah; Soliman, Nashaat M; Alduraywish, Abdulrahman; Mansour, Mahmoud Kamel; Mosaad, Mohamed; Ragheb, Mostafa M

doi:10.21608/aeji.2020.21321.1046

Coexistence of Spontaneous Bacterial Peritonitis and Spontaneous Bacterial Empyema Carries Poor Prognosis in Cirrhotic Patients with Ascites and Hydrothorax

Document Type : Original Article

Authors

¹ Chest Diseases and Tuberculosis Department, Faculty of Medicine, Suez Canal University, Egypt.

² Endemic and Infectious Disease Department, Faculty of Medicine, Suez Canal University, Egypt.

³ Internal Medicine Department, Jouf University, Saudi Arabia

⁴ Microbiology and Immunology Department, Faculty of Medicine, Suez Canal University, Egypt.

10.21608/aeji.2020.21321.1046

Abstract

Background and study aim:Patients with decompensated cirrhosis suffer from serious sequelae including infections that may endanger life. The study aimed at determination of the incidence, outcomes and risk factors of spontaneous bacterial empyema (SBEM) among patients with cirrhotic ascites and hydrothorax.
Patients and Methods: This study included 50 patients subjected to clinical, imaging and biochemical workup including diagnostic tapping of ascitic and pleural fluid to diagnose spontaneous bacterial peritonitis (SBP) by cellular count and SBEM by cellular count and culture.
Results: There The mean age was 57.14 years and 52% were males. SBP was found in 25 cases (50%); alone in 15 and with concomitant SBEM in 10. Only 7 (14%) had positive culture of the pleural fluid including five gram positive bacteria. Patients SBP and SBP/SBEM had significantly higher mean age, higher median TLC, and corrected PMN in pleural fluid compared to patients with no infection. The infection group stayed a significantly more duration in hospital. All the four deaths occurred in the infection group, three with SBP/SBEM and one with SBP. By multivariate logistic regression analysis, pleural fluid TLC and corrected PMN and duration of hospital stay were significant independent predictors of SBEM.
Conclusion: SBEM is a common sequel of hydrothorax in patients with cirrhotic ascites and its coexistence with SBP leads to higher morbidity and mortality.

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