Background: Bloodstream infections (BSIs) are among the most serious healthcare-associated infections encountered in intensive care units (ICUs). They contribute significantly to prolonged hospitalization, antimicrobial resistance, increased healthcare costs, and mortality. Understanding the epidemiological profile and microbial spectrum of BSIs is essential for optimizing empirical antimicrobial therapy and infection control practices.Objective: To evaluate the epidemiology, microbiological profile, antimicrobial resistance patterns, risk factors, and clinical outcomes of bloodstream infections among ICU patients.Methods: A retrospective observational study was conducted among 320 adult ICU patients with culture-confirmed bloodstream infections admitted to a tertiary care teaching hospital between January and December 2025. Demographic characteristics, clinical features, microbiological findings, antimicrobial susceptibility patterns, risk factors, treatment, and patient outcomes were analyzed.Results: The mean age of patients was 58.6 ± 15.1 years, with males accounting for 63.1% of cases. Gram-negative bacteria were isolated in 60.6% of cultures, Gram-positive organisms in 29.1%, and fungal pathogens in 10.3%. The most frequently isolated pathogens were Escherichia coli (24.1%), Klebsiella pneumoniae (21.3%), Staphylococcus aureus (17.2%), Pseudomonas aeruginosa (11.6%), Enterococcus species (9.4%), and Candida species (10.3%). Multidrug resistance was observed in 42.5% of bacterial isolates. Overall ICU mortality was 24.4%.Conclusion: Gram-negative multidrug-resistant organisms remain the predominant cause of ICU bloodstream infections. Early microbiological diagnosis, antimicrobial stewardship, and strict infection prevention strategies are essential to improve patient outcomes.