OBJECTIVESThis study explored the epidemiological trends and antimicrobial susceptibility patterns of bloodstream pathogens among pediatric patients over a 7-year period at a tertiary care facility in Saudi Arabia.METHODSThis retrospective single-center longitudinal descriptive study was conducted from 2015 to 2021. Blood culture and susceptibility data of pathogens isolated from patients aged <15 years were extracted from the hospital's laboratory information system. The trends observed over the 7-year period were graphically illustrated.RESULTSAmong the 83,605 pediatric blood cultures analyzed, 2945 (3.5 %) tested positive. Approximately 65 % of the positive cultures were confirmed as true bloodstream infections (BSIs), with an average BSI rate of 3 per 1000 inpatient days. Gram-negative bacterial infections accounted for 61 % of BSIs, with Klebsiella spp. being the most prevalent. Susceptibility testing revealed reduced sensitivity to meropenem, imipenem, ciprofloxacin, and levofloxacin among gram-negative bacteria. Gram-positive pathogens represented 39 % of infections, with the most common being Staphylococcus spp. (21 %) and Streptococcus spp. (7 %). Methicillin-resistant Staphylococcus aureus exhibited 100 % sensitivity to vancomycin, quinupristin/dalfopristin, tigecycline, and linezolid. However, Streptococcus pneumoniae showed decreasing sensitivity to penicillin and ceftriaxone for meningitis (33 % and 55 % susceptibility, respectively). Furthermore, Enterococcus spp. were less susceptible against ampicillin, linezolid, levofloxacin, and vancomycin.CONCLUSIONSThe findings of this study offer crucial insights into the incidence of pediatric bacteremia and trends in antibiotic susceptibility, which can inform treatment strategies, guide antibiotic stewardship programs, and enhance infection control measures in healthcare settings.