PDF(Pubmed)
Abstract：
BACKGROUND: Spontaneous bacterial empyema (SBE) occurs when a hepatic hydrothorax becomes infected and runs a course similar to spontaneous bacterial peritonitis (SBP). It remains underdiagnosed as patients with cirrhosis do not routinely undergo diagnostic thoracentesis. Current understanding is limited by small cohorts, while studies reporting its association with ascites/SBP are conflicting.
OBJECTIVE: To explore the incidence of SBE, to determine its association with ascites, and to summarize what is known regarding treatment and outcomes for patients with SBE.
METHODS: Major databases were searched until June 2021. Outcomes include the incidence of SBE in pleural effusions, SBP in peritoneal fluid, and SBE in patients without ascites within our cohort of patients with cirrhosis. We performed a meta-analysis using a random-effects model with pooled proportions and 95% confidence intervals (CI). We assessed heterogeneity using I 2 and classic fail-safe to determine bias.
RESULTS: Eight studies with 8899 cirrhosis patients were included. The median age ranged between 41.2 to 69.7 years. The majority of the patients were Child-Pugh B and C. Mean MELD score was 18.6 ± 8.09. A total of 1334 patients had pleural effusions and the pooled incidence of SBE was 15.6% (CI 12.6-19; I 2 50). Amongst patients diagnosed with SBE, the most common locations included right (202), left (64), and bilateral (8). Amongst our cohort, a total of 2636 patients had ascites with a pooled incidence of SBP of 22.2% (CI 9.9-42.7; I 2 97.8). The pooled incidence of SBE in patients with cirrhosis but without concomitant ascites was 9.5% (CI 3.6-22.8; I 2 82.5).
CONCLUSIONS: SBE frequently occurs with concurrent ascites/SBP; our results suggest high incidence rates of SBE even in the absence of ascites. The pleura can be an unrecognized nidus and our findings support the use of diagnostic thoracentesis in patients with decompensated cirrhosis after exclusion of other causes of pleural effusion. Thoracentesis should be considered particularly in patients without ascites and when there is a high suspicion of infection. The need for diagnostic thoracentesis will continue to be important as rates of multi-drug resistant bacterial infections increase and antibiotic susceptibility information is required for adequate treatment.
OBJECTIVE: To explore the incidence of SBE, to determine its association with ascites, and to summarize what is known regarding treatment and outcomes for patients with SBE.
METHODS: Major databases were searched until June 2021. Outcomes include the incidence of SBE in pleural effusions, SBP in peritoneal fluid, and SBE in patients without ascites within our cohort of patients with cirrhosis. We performed a meta-analysis using a random-effects model with pooled proportions and 95% confidence intervals (CI). We assessed heterogeneity using I 2 and classic fail-safe to determine bias.
RESULTS: Eight studies with 8899 cirrhosis patients were included. The median age ranged between 41.2 to 69.7 years. The majority of the patients were Child-Pugh B and C. Mean MELD score was 18.6 ± 8.09. A total of 1334 patients had pleural effusions and the pooled incidence of SBE was 15.6% (CI 12.6-19; I 2 50). Amongst patients diagnosed with SBE, the most common locations included right (202), left (64), and bilateral (8). Amongst our cohort, a total of 2636 patients had ascites with a pooled incidence of SBP of 22.2% (CI 9.9-42.7; I 2 97.8). The pooled incidence of SBE in patients with cirrhosis but without concomitant ascites was 9.5% (CI 3.6-22.8; I 2 82.5).
CONCLUSIONS: SBE frequently occurs with concurrent ascites/SBP; our results suggest high incidence rates of SBE even in the absence of ascites. The pleura can be an unrecognized nidus and our findings support the use of diagnostic thoracentesis in patients with decompensated cirrhosis after exclusion of other causes of pleural effusion. Thoracentesis should be considered particularly in patients without ascites and when there is a high suspicion of infection. The need for diagnostic thoracentesis will continue to be important as rates of multi-drug resistant bacterial infections increase and antibiotic susceptibility information is required for adequate treatment.
摘要：
背景：自发性细菌性脓胸（SBE）发生在肝性胸腔积液被感染时，其病程与自发性细菌性腹膜炎（SBP）相似。由于肝硬化患者通常不接受诊断性胸腔穿刺术，因此仍未被诊断。目前的理解受到小群体的限制，虽然报告其与腹水/SBP相关的研究相互矛盾。
目的：探讨SBE的发病率，为了确定它与腹水的联系，并总结关于SBE患者的治疗和结局的已知情况。
方法：主要数据库的搜索一直持续到2021年6月。结果包括胸膜积液中SBE的发生率，腹膜液中SBP,和SBE在我们的肝硬化患者队列中没有腹水的患者。我们使用具有合并比例和95％置信区间（CI）的随机效应模型进行了荟萃分析。我们使用I2和经典的故障安全来评估异质性，以确定偏倚。
结果：包含8899例肝硬化患者的8项研究。中位年龄在41.2至69.7岁之间。大多数患者为Child-PughB和C。平均MELD评分为18.6±8.09。共有1334例患者出现胸腔积液，SBE的合并发生率为15.6%（CI12.6-19；I250）。在被诊断为SBE的患者中，最常见的位置包括右(202)，左（64），和双边（8）。在我们的队列中，共有2636例患者出现腹水,合并SBP的发生率为22.2%(CI9.9~42.7;I297.8).在肝硬化但无伴随腹水的患者中，SBE的合并发生率为9.5％（CI3.6-22.8；I282.5）。
结论：SBE经常发生并发腹水/SBP；我们的结果表明，即使没有腹水，SBE的发生率也很高。胸膜可能是无法识别的病灶，我们的发现支持在排除其他原因的胸腔积液后，对失代偿期肝硬化患者使用诊断性胸腔穿刺术。特别是在没有腹水和高度怀疑感染的患者中，应考虑进行胸腔穿刺术。随着多药耐药细菌感染率的增加以及适当治疗需要抗生素敏感性信息，对诊断性胸腔穿刺术的需求将继续很重要。
目的：探讨SBE的发病率，为了确定它与腹水的联系，并总结关于SBE患者的治疗和结局的已知情况。
方法：主要数据库的搜索一直持续到2021年6月。结果包括胸膜积液中SBE的发生率，腹膜液中SBP,和SBE在我们的肝硬化患者队列中没有腹水的患者。我们使用具有合并比例和95％置信区间（CI）的随机效应模型进行了荟萃分析。我们使用I2和经典的故障安全来评估异质性，以确定偏倚。
结果：包含8899例肝硬化患者的8项研究。中位年龄在41.2至69.7岁之间。大多数患者为Child-PughB和C。平均MELD评分为18.6±8.09。共有1334例患者出现胸腔积液，SBE的合并发生率为15.6%（CI12.6-19；I250）。在被诊断为SBE的患者中，最常见的位置包括右(202)，左（64），和双边（8）。在我们的队列中，共有2636例患者出现腹水,合并SBP的发生率为22.2%(CI9.9~42.7;I297.8).在肝硬化但无伴随腹水的患者中，SBE的合并发生率为9.5％（CI3.6-22.8；I282.5）。
结论：SBE经常发生并发腹水/SBP；我们的结果表明，即使没有腹水，SBE的发生率也很高。胸膜可能是无法识别的病灶，我们的发现支持在排除其他原因的胸腔积液后，对失代偿期肝硬化患者使用诊断性胸腔穿刺术。特别是在没有腹水和高度怀疑感染的患者中，应考虑进行胸腔穿刺术。随着多药耐药细菌感染率的增加以及适当治疗需要抗生素敏感性信息，对诊断性胸腔穿刺术的需求将继续很重要。
