An intraoperative bile culture does not improve the outcomes or guide antibiotic management in acute cholecystitis: A Propensity-Weighted analysis.

The Tokyo Guidelines of 2018 recommend performing an intraoperative bile culture for acute cholecystitis. However, their clinical significance remains unclear. We evaluated the impact of performing a bile culture on the perioperative outcomes. We retrospectively analyzed 344 patients who underwent cholecystectomy for acute cholecystitis between 2015 and 2024. The patients were classified into a culture group (n = 248) and a non-culture group (n = 96). The inverse probability of treatment weighting was applied to adjust for baseline differences. The perioperative outcomes were compared and the influence of performing a bile culture on antibiotic management was assessed. The culture group had more Grade II/III tumors (p < 0.05). After adjustment, drain placement was more frequent (73.2% vs. 58.9%; p = 0.01). No significant differences were observed in the operative time (100 vs. 87 min, p = 0.10), gallbladder perforation (32.9% vs. 30.0%, p = 0.85), hospital stay (5 vs. 4 days, p = 0.30), or complications (24.0% vs. 18.0%, p = 0.273). In the culture group, 71.8% of the patients completed antibiotics before the culture results. Therapy was changed in only 2.0% of the patients. Although a bile culture is often performed in severe cases, it rarely influences the antibiotic strategy or improves the outcomes. Therefore, performing a routine intraoperative bile culture, as recommended by the Tokyo Guidelines 2018, may have limited utility.