Background: Blood stream infection is one of the most important causes of morbidity andrnmortality globally. Staphylococcus aureus, coagulase negative staphylococus, Streptococcusrnpneumonia are major Gram- positive bacteria in causing blood stream infection. Escherichiarncoli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii are majorrnGram-negative bacteria in causing blood stream infections. Development of multidrug resistancernin major bacteria has increased the morbidity and mortality rate of blood stream infection.rnObjective: To determine bacterial etiology of blood stream infection, the prevalence ofrnmultidrug resistance,XDR, Pan drug resistance and extended spectrum beta lactamase productionrnof bacterial isolates.Methods:The present study was a laboratory based cross sectional studyrnconducted at Arsho Advanced Medical Laboratory, Addis Ababa Ethiopia from Dec 2020 tornJune 2021.A total 0f 422 blood sample was collected and inoculated onto primary isolationrnfollowing standards protocols. Species identification and antimicrobial susceptibility testing ofrnbacteria were determined by automated Vitek 2 compact system (Bio Merieux,France) by usingrnAST,GN72 card for gram negatives and AST,GP71 card for gram positive bacteria.rnResults: Out of a total 422 samples processed, bacterial pathogens were isolated from 67(16%)rnsamples. Among the isolates,40(59.7) were gram-negative and 27(40.3) were gram-positivernbacteria. Klebsiella spp and Coagulase negative staphylococci were the dominat isolates. Ofrnthese isolates, 6 (60%) were ESBL positive for K.pneumonae,1(50%) for K.oxytoca andrn4(66.7%) for E.coli.rnPenicillin(90.2%) was the least effective antibiotic against Gram-positive bacteria whilernAmpicillin(87.5%) were the least effective antibiotic against Gram-negativernbacteria.Piperacillin(92.5%) were the most effective antibiotic against Gram-negative andrnTigecycline(91.7%) were the most effective antibiotic against Gram-positive bacteria. Out of 40rnisolate of Gram-negative bacteria 21(52.5%) were MDR and from 27 isolates of Gram-positivernbacteria16 (59.3%) were MDR.Conclusion: The magnitude of blood stream bacterial infectionrnand the prevalence rate of multi-drug resistant bacterial strains causing blood stream infectionsrnwere high. These findings were warranted the need for the continuous investigation of bacterialrnblood stream infection.