Introduction : This study is to evaluate the distribution & antibiotics sensitivity of intraoperative bile culture according to severity of acute cholecystitis.

Methods : From 2015 to 2018, 1002 patients underwent cholecystectomy at Dongtan Sacred Heart Hospital and the results of intraoperative bile culture were analyzed. The diagnostic criteria & severity grade of acute cholecystitis are refer to Tokyo Guidelines 2018.

Results : Of total 1002 patients, positive bile culture was detected in 218 (21%) and distribution of grade 1 (G1), 2 (G2), 3 G(3) were 114/464 (24%), 76/177 (43%), 28/44 (70%), respectively. Most common bacteria was Enterococcus species & followed by E.coli, Klebsiella and the number of bacterial species by each group was the same order. Enterococcus species were detected 46/190 (24%) in G1&2 and 12/28 (42%) in G3 (p=0.037), E.Coli species were 35/190 (18%) in G1&2 and 10/28 (35%) in G3(p=0.035), respectively. However, Klebsiella species were not statistically significant result (30/190[15%], G1&2 and 3/30[10%], G3, p=0.585). For antibiotics sensitivity test, Enterococcus species had no statistical differences between the penicillin or quinolone sensitivity according to severity of grade (p=0.681, P=0.686, respectively) and nor had E.coli and Klebsiella species for sensitivity of 2nd and 3rd cephalosporin (p=1.000, P=1.000,respectively).

Conclusions : The most common strains of bile culture conducted with acute cholecystitis was Enterococcus species, followed by E coli and Klebsiella. The more severe grade, the more significant the ratio of Enterococcus and E Coli has been detected. Therefore, it would be important to choose proper antibiotics and management, if the severity of acute cholecystitis increases.