title: Spontaneous bacterial empyema.
abstract: OBJECTIVE
  Spontaneous bacterial empyema (SBEM) is defined as spontaneous infection of a preexisting hepatic hydrothorax. SBEM is diagnosed after exclusion of pneumonia, and, in patients with liver cirrhosis, it is still associated with significant morbidity and mortality. To date, studies focusing on SBEM are rare. This review will highlight the recent data focusing on the clinical characteristics, bacteriology, management, and outcome predictors of cirrhotic patients with SBEM.
  
  
  RESULTS
  The Enterobacteriaceae (Escherichia coli and Klebsiella pneumoniae) are the major causative pathogens isolated from SBEM patients. Therefore, the cornerstone of therapy is antibiotic therapy with immediate empirical use of third-generation cephalosporins as first-line treatment. Chest-tube placement is not necessary. Regression analysis identified three independent factors related to poor outcome: high score of the model for end-stage liver disease-sodium (MELD-Na), initial ICU admission, and initial antibiotic treatment failure. High MELD-Na score may be a useful predictor of SBEM mortality in cirrhotic patients.
  
  
  CONCLUSIONS
  Although SBEM is a rare complication of cirrhosis, the high mortality rate should increase physicians' index of suspicion in cirrhotic patients with hydrothorax and prompt immediate diagnostic thoracentesis. The MELD-Na score rather than Child-Pugh score may be a strong predictor of in-hospital mortality of SBEM patients.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chih-Yen
authors.initials: CY
authors.lastname: Tu
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Chen
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D004653:Empyema / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D017052:Hospital Mortality; D006801:Humans; D006876:Hydrothorax / Q000150:complications*; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D011379:Prognosis; D012044:Regression Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents