Objective：This study retrospectively analyzed data from patients with Gram-negative（G- ）bacilli bloodstream infections to summarize the incidence and clinical outcomes of sepsis-associated encephalopathy（SAE）in these patients. Methods：The data of febrile patients treated in the Emergency Medicine Center of the First Affiliated Hospital of Nanjing Medical University from January 2021 to June 2024 were reviewed. Patients with G-bacilli - positive blood cultures at initial emergency presentation meeting sepsis diagnostic criteria were enrolled. Based on SAE development during the disease course，patients were categorized into SAE and non -SAE groups. Propensity score matching（PSM）was used to adjust for confounding factors between groups，followed by 30- day Kaplan-Meier（K-M）survival curves analysis. Results：A total of 207 patients were included in the study，with 92（44.4%）developing SAE. The 30- day survival rate was lower in the SAE group than in the non - SAE group（69.6% vs. 97.4%，P ＜ 0.001）. After PSM adjustment for baseline characteristics，the SAE group exhibited worse outcomes：lower the 30-day survival（72.3% vs. 100.0%，P ＜ 0.001）， longer ICU stays[5（0，11）d vs. 0（0，5）d，P ＜ 0.001]，higher rates of invasive mechanical ventilation（MV）（40.0% vs. 1.5%，P ＜ 0.001）， continuous renal replacement therapy（CRRT）（32.3% vs. 4.6%，P ＜ 0.001），and use of vasoactive drugs（50.8% vs. 15.4%，P ＜ 0.001）. The K-M curve demonstrated significantly poorer 30-day survival in the SAE group（HR=8.730，95% CI：3.443-22.140，P ＜ 0.001）. Conclusion：SAE is a common complication in septic patients with G-bacilli bloodstream infections and leads to poor prognosis.