AIM: The aim of this work was to assess the frequency of spontaneous bacterial empyema in cirrhotic patients with ascites and determine the possible associated risk factors of spontaneous bacterial empyema in those patients. MATERIALS AND METHODS: 322 cirrhotic patients with ascites and pleural effusion were enrolled. Spontaneous bacterial empyema was diagnosed by positive pleural fluid culture or, if negative, a pleural fluid PMNL count >500 cells/mm3 without radiographic evidence of pneumonia or a contiguous infection process on chest radiography. RESULTS: The frequency of spontaneous bacterial empyema (SBEM) among cirrhotic patients with ascites and hepatic hydrothorax was 14.3% (46 out of 322 cirrhotic patients). E.Coli was the commonest organism (54.8%) responsible for SBEM in positive culture cases. CONCLUSION: SBEM was recognized in 14.3% of cirrhotic patients with ascites and hepatic hydrothorax. So, it is a frequent but underdiagnosed complication of hepatic hydrothorax and has a poor prognosis.