There were 868 nosocomial bloodstream infections detected in 29,273 subjects (overall rate, 2.94 episodes per 100 discharges). Infection rates were greatest among children admitted to the neonatal intensive care unit and lowest for those admitted to the school-age ward and the infectious diseases ward. There was a significant decrease in rates of nosocomial bacteremia in all of the wards. The organisms isolated most commonly were Klebsiella pneumoniae, Candida species, and coagulase-negative staphylococci. Mortality rates were higher for children with a gram-negative bacterial bloodstream infection (45.2%) and lower for children with a gram-positive bacterial infection (19.2%).Conclusions. Rates of nosocomial bloodstream infection decreased over the past 15 years at our hospital but continue to cause significant mortality. Continuing efforts to decrease the frequency of and mortality due to bloodstream infection are warranted.