Bloodstream infections (BSIs) in intensive care units (ICUs) pose significant challenges due to their high morbidity and mortality rates. These infections can be caused by various pathogens, classified as community-onset or hospital-acquired, and primary or secondary in origin. The microbiology of ICU BSIs varies globally, with Gram-positive pathogens prevalent in the United States and Gram-negative organisms more common in Europe, Asia, and Latin America. The incidence of ICU BSIs increased during the COVID-19 pandemic, and BSIs complicating SARS-CoV-2 infection significantly increase the risk of death. Antimicrobial resistance (AMR) is a growing concern, particularly in methicillin-resistant *Staphylococcus aureus*, carbapenem-resistant Enterobacterales, and *Acinetobacter baumannii*. Preventive measures and increased collaboration between infectious disease specialists and intensivists can improve patient outcomes. Recent studies highlight the importance of early and appropriate antimicrobial therapy and source control in managing ICU BSIs. The pandemic has also impacted the epidemiology and microbiology of ICU BSIs, with higher rates of BSIs in COVID-19 patients and a distinct impact on the types of pathogens isolated. Multi-drug-resistant organisms, such as CRE, AB, and MRSA, continue to pose significant challenges, with high mortality rates and varying incidence patterns globally. Effective prevention strategies, antimicrobial stewardship, and enhanced collaboration between healthcare professionals are crucial for improving outcomes in patients with ICU BSIs.Bloodstream infections (BSIs) in intensive care units (ICUs) pose significant challenges due to their high morbidity and mortality rates. These infections can be caused by various pathogens, classified as community-onset or hospital-acquired, and primary or secondary in origin. The microbiology of ICU BSIs varies globally, with Gram-positive pathogens prevalent in the United States and Gram-negative organisms more common in Europe, Asia, and Latin America. The incidence of ICU BSIs increased during the COVID-19 pandemic, and BSIs complicating SARS-CoV-2 infection significantly increase the risk of death. Antimicrobial resistance (AMR) is a growing concern, particularly in methicillin-resistant *Staphylococcus aureus*, carbapenem-resistant Enterobacterales, and *Acinetobacter baumannii*. Preventive measures and increased collaboration between infectious disease specialists and intensivists can improve patient outcomes. Recent studies highlight the importance of early and appropriate antimicrobial therapy and source control in managing ICU BSIs. The pandemic has also impacted the epidemiology and microbiology of ICU BSIs, with higher rates of BSIs in COVID-19 patients and a distinct impact on the types of pathogens isolated. Multi-drug-resistant organisms, such as CRE, AB, and MRSA, continue to pose significant challenges, with high mortality rates and varying incidence patterns globally. Effective prevention strategies, antimicrobial stewardship, and enhanced collaboration between healthcare professionals are crucial for improving outcomes in patients with ICU BSIs.