الفهرس 
Acknowledgment.Only 14 pages are availabe for public view
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Abstract
Hepatic hydrothorax is a relatively uncommon complication of end-stage liver insufficiency with an estimated prevalence of 5–10%. Spontaneous bacterial empyema (SBEM) is an infection of a preexisting hydrothorax in a cirrhotic patient that cannot be attributed to chest condition. It is associated with a bad prognosis and mortality rate may reach over 20%. Infection is usually by enteric bacteria which reach pleural cavity by hematogenous spread; though transfer through bowel wall can occur.
The aim of this study was to assess the frequency, patterns, bacterial profiles and risk factors associated with spontaneous bacterial empyema among patients with hepatic hydrothorax associated with cirrhotic ascites.
This prospective follow up study was carried out in the Suez Canal University Hospital from January to August 2011. The study included 50 patients admitted to internal medicine ward, all had with hydrothorax associated with cirrhotic ascites. Patients with chest diseases that explained pleural effusion due to other causes or patients on anti-microbial treatment were excluded. The lab studies were achieved in the clinical pathology laboratory of the hospital while the bacteriological assessment was done in the department of Medical Bacteriology and Immunology, Faculty of Medicine, Suez Canal University.
Patients Spontaneous bacterial infection in pleural (SBEM) and/or ascitc (SBP) fluids were diagnosed if there corrected PMN counts exceeded 250/cmm in addition to culture positive finding or exceeded 500/cmm with negative culture. Follow up continued till discharge or death.
The studied patients were 26 males and 24 females. Their ages ranged between 43 and 73 years (Mean=57.14). The study revealed SBEM was in 10 patients (20%), all had SBP as well. In the remaining 40 patients, 15 patients had SBP and 25 had no evidence of either infections. In our cases, fever and abdominal tenderness were significantly more frequent in patients with infection (P=0.0003 and 0.005 respectively). In 10 patients with both infections, dyspnea was found in 19, abdominal pain in 33, chest pain in one, chest tenderness in 10, abdominal tenderness in 31, altered consciousness in 5.
In the present study, only 7 pleural fluid cultures (14%) were positive for bacterial growth, S. aureus in 3, Pseudomonas in two (4%), and Diphtroid and S. epidermidis in one each. Thus our cultures yielded gram positive cocci in 4 (57.1%), gram negative bacilli in 28.6% and anerobic organism in one (14.3%). Our study confirmed the increading frequency of gram positive cocci over the last years.This changing pattern of the infectious agents in cirrhotic patients is probably due to the increasingly use of quinolones in treatment and prevention of SBP.