ABSTRACT Objectives Bacteraemia during the course of neutropenia is often fatal. We aimed to identify factors predicting mortality to have an insight into better clinical management. Methods The study has a prospective, observational design using pooled data from febrile neutropenia patients with bacteraemia in 41 centres in 16 countries. Polymicrobial bacteraemias were excluded. It was performed through the Infectious Diseases–International Research Initiative platform between 17 March 2021 and June 2021. Univariate analysis followed by a multivariate binary logistic regression model was used to determine independent predictors of 30-d in-hospital mortality (sensitivity, 81.2%; specificity, 65%). Results A total of 431 patients were enrolled, and 85 (19.7%) died. Haematological malignancies were detected in 361 (83.7%) patients. Escherichia coli (n = 117, 27.1%), Klebsiellae (n = 95, 22% %), Pseudomonadaceae (n = 63, 14.6%), Coagulase-negative Staphylococci (n = 57, 13.2%), Staphylococcus aureus (n = 30, 7%), and Enterococci (n = 21, 4.9%) were the common pathogens. Meropenem and piperacillin-tazobactam susceptibility, among the isolated pathogens, were only 66.1% and 53.6%, respectively. Pulse rate (odds ratio [OR], 1.018; 95% confidence interval [CI], 1.002–1.034), quick SOFA score (OR, 2.857; 95% CI, 2.120–3.851), inappropriate antimicrobial treatment (OR, 1.774; 95% CI, 1.011–3.851), Gram-negative bacteraemia (OR, 2.894; 95% CI, 1.437–5.825), bacteraemia of non-urinary origin (OR, 11.262; 95% CI, 1.368–92.720), and advancing age (OR, 1.017; 95% CI, 1.001–1.034) were independent predictors of mortality. Bacteraemia in our neutropenic patient population had distinctive characteristics. The severity of infection and the way to control it with appropriate antimicrobials, and local epidemiological data, came forward. Conclusions Local antibiotic susceptibility profiles should be integrated into therapeutic recommendations, and infection control and prevention measures should be prioritised in this era of rapidly increasing antibiotic resistance. Introduction Neutropenic patients cannot mount normal immune responses, and disseminated infection like bacteraemia can arise without obvious symptoms and clinical findings, but the fever solely. Bacteraemia during neutropenia is significantly more often fatal compared with non-neutropenic patients [1]. In addition, increasing multi-drug resistant microorganisms causing bacteraemia has become a serious challenge for clinicians [2]. Although current guidelines commonly used in the antimicrobial management of febrile neutropenia [3], [4], [5], [6] are generated in countries with sufficient laboratory and antibiotic resources where antibiotic resistance is relatively low [7], the guidelines emphasise using local antibacterial resistance patterns in determining empirical therapeutic strategies. Thus, the selection of empirical antimicrobial therapy in febrile neutropenia is both of the utmost importance and a major challenge. In this study, we aimed to identify the factors predicting 30-d in-hospital mortality, provide epidemiological data regarding antimicrobial resistance, and illustrate the importance of antibiotic stewardship policies.