 This study found that bloodstream infections caused by antimicrobial resistant gram-negative bacteria are a significant cause of morbidity and mortality in Lusaka, Zambia. It also showed that the use of third-generation cephalosporins as an empiric treatment for these infections can lead to the development of extended spectrum beta-lactamases, which can further increase the risk of death. Additionally, the study found that the odds of death were higher in patients who received third-generation cephalosporins as an empiric treatment compared to those who received fourth-generation cephalosporins or no cephalosporin at all. Therefore, it is important to implement structured surveillance, yearly anti-biogram updates, improved infection control, and a well-functioning antimicrobial stewardship program to ensure appropriate antimicrobial treatment selection and favorable patient outcomes. This article was authored by Kanda Yamba, Shilishi Laquaysa Muziani, Molumbotilica Sumutila, and others.