Bloodstream infections (BSIs) in the intensive care unit (ICU) are a significant challenge, with high morbidity and mortality. These infections can be caused by various pathogens, classified as community or hospital-acquired, or primary or secondary. Gram-positive organisms are more common in the US, while Gram-negative organisms are more prevalent in Europe, Asia, and Latin America. The incidence of ICU BSIs increased during the pandemic, and those complicating SARS-CoV-2 infections are more likely to result in death. Antimicrobial resistance (AMR) is rising, complicating treatment. Preventive measures and collaboration between infectious disease specialists and intensivists are crucial for improving outcomes. ICU BSIs are often associated with central venous catheters (CVCs), and their management is critical. The epidemiology and microbiology of ICU BSIs vary globally, with different pathogens and resistance patterns. In the US, over 6900 ICU patients had BSIs, with 80% being community-onset. Gram-positive organisms, particularly Staphylococcus aureus, were the most common pathogens. In Europe, Gram-negative organisms predominated, with Acinetobacter spp. being more common. In the US, MRSA is more prevalent, while in Europe and Latin America, carbapenem-resistant Enterobacterales (CRE) and Acinetobacter baumannii are more concerning. The pandemic increased the risk of ICU BSIs, with a higher incidence in patients with SARS-CoV-2 infections. Studies show that patients with ICU BSIs and SARS-CoV-2 are more likely to die. AMR is more common in ICU-onset BSIs, particularly in Gram-negative organisms. The mortality rate for ICU BSIs is high, with nearly a third of patients dying. The risk of mortality is also higher in patients with multidrug-resistant (MDR) Gram-negative BSIs. MDR pathogens like CRE, AB, and MRSA are a major concern. CRE is more common in Latin America, while AB is more prevalent in Europe and Asia. MDR rates are high for AB, with 70.6% being MDR. Patients with AB infections have poor outcomes, especially if resistant to colistin. Risk factors for AB BSIs include immunocompromised status and central nervous system infections. Preventive measures and antimicrobial stewardship are essential to reduce AMR and improve outcomes. Collaboration between infectious disease specialists and intensivists is crucial for improving patient outcomes. Studies show that patients seen by infectious disease specialists have higher survival rates. Rapid diagnostics and appropriate antimicrobial therapy are important for effective treatment. Overall, ICU BSIs remain a significant challenge, with high morbidity and mortality, requiring a multifaceted approach to improve outcomes.Bloodstream infections (BSIs) in the intensive care unit (ICU) are a significant challenge, with high morbidity and mortality. These infections can be caused by various pathogens, classified as community or hospital-acquired, or primary or secondary. Gram-positive organisms are more common in the US, while Gram-negative organisms are more prevalent in Europe, Asia, and Latin America. The incidence of ICU BSIs increased during the pandemic, and those complicating SARS-CoV-2 infections are more likely to result in death. Antimicrobial resistance (AMR) is rising, complicating treatment. Preventive measures and collaboration between infectious disease specialists and intensivists are crucial for improving outcomes. ICU BSIs are often associated with central venous catheters (CVCs), and their management is critical. The epidemiology and microbiology of ICU BSIs vary globally, with different pathogens and resistance patterns. In the US, over 6900 ICU patients had BSIs, with 80% being community-onset. Gram-positive organisms, particularly Staphylococcus aureus, were the most common pathogens. In Europe, Gram-negative organisms predominated, with Acinetobacter spp. being more common. In the US, MRSA is more prevalent, while in Europe and Latin America, carbapenem-resistant Enterobacterales (CRE) and Acinetobacter baumannii are more concerning. The pandemic increased the risk of ICU BSIs, with a higher incidence in patients with SARS-CoV-2 infections. Studies show that patients with ICU BSIs and SARS-CoV-2 are more likely to die. AMR is more common in ICU-onset BSIs, particularly in Gram-negative organisms. The mortality rate for ICU BSIs is high, with nearly a third of patients dying. The risk of mortality is also higher in patients with multidrug-resistant (MDR) Gram-negative BSIs. MDR pathogens like CRE, AB, and MRSA are a major concern. CRE is more common in Latin America, while AB is more prevalent in Europe and Asia. MDR rates are high for AB, with 70.6% being MDR. Patients with AB infections have poor outcomes, especially if resistant to colistin. Risk factors for AB BSIs include immunocompromised status and central nervous system infections. Preventive measures and antimicrobial stewardship are essential to reduce AMR and improve outcomes. Collaboration between infectious disease specialists and intensivists is crucial for improving patient outcomes. Studies show that patients seen by infectious disease specialists have higher survival rates. Rapid diagnostics and appropriate antimicrobial therapy are important for effective treatment. Overall, ICU BSIs remain a significant challenge, with high morbidity and mortality, requiring a multifaceted approach to improve outcomes.