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Sepsis and bacteremia are closely linked; while bacteremia refers to the presence of bacteria in blood cultures, sepsis is a clinical diagnosis of organ dysfunction caused by infection. Because most cases of sepsis and bacteremia are admitted as emergencies, the emergency department plays a critical role in diagnosis and early treatment. In this study, the focus was on antibiotic therapy and therefore bacteremia was our inclusive criterion. Our goal was to identify possible resistance to empirically given antibiotic therapies and to assess the link between the adequacy of antibiotic choice and mortality. We conducted a retrospective analysis. Our study cohort included patients admitted to Semmelweis University ED between Mid June 2016 and end of September 2022 who had blood culture sampling at the ED. In this time period, blood cultures were obtained in 4,647 cases of all around 158,000 admissions. This corresponds to 3% of all admission cases. Blood cultures were positive for bacteria in 33% of the cases. Antibiotics were administered in 1,111 of these cases – these made up our study cohort. Survival analysis was performed for 1042 cases. Our study included 1,111 cases with an average age of 72 years. The most common discharge codes were sepsis in slightly more than 50% of cases, followed by urinary system disorders and pneumonia in about 20% of cases each. The four most common antibiotics were ceftriaxone, piperacillin-tazobactam, clarithromycin, and meropenem - bacterial resistance to the chosen antibiotic was found in 7.8%, 9.8%, 23.3%, and 0.6% of cases, respectively. Ceftriaxone was predominantly used in combination therapy in about 58% of the cases, while piperacillin-tazobactam was primarily used as monotherapy (80.9%). Resistance to at least one given antibiotic was found in 157 cases, this corresponds to 14.1% of cases. In more than one third of the cases, E. coli was responsible for this resistance. Most of these resistant E. coli strains were ESBL producing. Here we see a table showing which antibiotics were given to which bacteria found and what the respective resistance was. It‘s an extract from the complete table and shows the most common bacteria species that were resistant to at least one given antibiotic. E. coli was not only the most common bacterium found in the blood cultures, pathogen-specific resistance analysis showed that it was also the most common resistant species. Patients with E. coli infection who received the two most common antibiotics ceftriaxone or piperacillin/tazobactam were resistant to it in 20% and 24.3% of cases, respectively. The overall resistance against ED antibiotic of E. coli positive cases was 16.5% with a high prevalence of ESBL strains. Staphylococci had the highest rates of resistance, often to clarithromycin, but this was usually given in combination therapy, for example, together with ceftriaxone. Overall 30-day and one-year mortality was 39.1%, and 61.2%, respectively. There was no difference in the long-term survival between cases with and without bacteria resistant to a given antibiotic (p = 0.162). However, ED antibiotic resistance was linked to worse 1-year mortality in the subgroup of patients who had E. coli infection.