Refractory Spontaneous Bacterial Empyema in Cirrhotic Patient

Table 3

Summary of recommendations.

Diagnostic criteria	1. No evidence of pneumonia on chest imaging.
	2. Positive pleural fluid culture and; PMN cell count >250 cells/mm^3.	or	Negative pleural fluid culture and; PMN cell count >500 cells/mm^3.
Diagnostic workup	Chest imaging to rule out pneumonia. Diagnostic thoracentesis.
Treatment	First-line antibiotic therapy: third-generation cephalosporin. Manage hepatic hydrothorax and underlying cirrhosis. Outpatient oral antibiotics to prevent a recurrence.

PMN = polymorphonuclear.