{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T19:20:44Z","timestamp":1788808844449,"version":"build-2803163510"},"reference-count":50,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Bacteremia is associated with worse outcomes in sepsis, but comparative data between Gram-positive bacteremia (GPB) and Gram-negative bacteremia (GNB) remain scarce. We compared clinical characteristics, empirical antibiotic appropriateness, and outcomes of GPB and GNB in emergency department (ED) patients with sepsis. Materials and Methods: We retrospectively studied ED patients who met the Sepsis-3 criteria with culture-confirmed GPB or GNB from December 2021 to August 2024. The primary outcome was 28-day mortality. Secondary outcomes included 90-day mortality, in-hospital mortality, ICU admission, and length of hospital stay. Multivariable logistic regression assessed the association between Gram status and 28-day mortality. Results: Of 493 patients, 96 had GPB and 397 had GNB. GPB was associated with higher 28-day mortality (26.0% vs. 9.3%), 90-day mortality (34.4% vs. 11.8%), in-hospital mortality (26.0% vs. 10.1%), ICU admission (36.5% vs. 24.7%), longer hospital stay (20.5 [11.8\u201331.0] vs. 14.0 [9.0\u201320.0] days), and substantially more frequent inappropriate empirical antibiotic therapy (37.5% vs. 12.8%) (all p &lt; 0.05). The independent association between GPB and 28-day mortality was not consistent across adjusted models and was attenuated after accounting for inappropriate empirical antibiotic therapy (aOR, 1.85; 95% CI, 0.92\u20133.71). In exploratory analyses, GPB was associated with four-fold higher odds of inappropriate empirical antibiotic therapy than GNB (aOR, 4.07; 95% CI, 2.19\u20137.54). Conclusions: In bacteremic sepsis, GPB was associated with worse observed outcomes and substantially more frequent inappropriate empirical antibiotic therapy than GNB. GPB should be interpreted less as a standalone microbiologic determinant of mortality and more as a marker of a clinically vulnerable and management-challenging profile. Our findings point to a modifiable diagnostic\u2013treatment gap in early ED recognition and empirical antibiotic selection. Prospective multicenter studies should evaluate whether systematic reassessment of clinical features suggestive of GPB and suspected infection source can improve empirical antibiotic appropriateness and ultimately translate into better clinical outcomes.<\/jats:p>","DOI":"10.3390\/medicina62071353","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:55:21Z","timestamp":1783990521000},"page":"1353","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Characteristics, Empirical Antibiotic Appropriateness, and Outcomes of Gram-Positive Versus Gram-Negative Bacteremia in Emergency Department Patients with Sepsis"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0756-1620","authenticated-orcid":false,"given":"Taekwon","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu 42601, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0969-5115","authenticated-orcid":false,"given":"Jonghoon","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu 42601, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4303-7375","authenticated-orcid":false,"given":"Sang-hun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu 42601, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2465-2172","authenticated-orcid":false,"given":"Wondong","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Keimyung University Dongsan Hospital, Daegu 42601, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e1063","DOI":"10.1097\/CCM.0000000000005337","article-title":"Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021","volume":"49","author":"Evans","year":"2021","journal-title":"Crit. 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