Objective To investigate the distribution and antimicrobial resistance of common clinical pathogens from blood specimens in China. Methods Antimicrobial resistance of bacterial isolates from all blood culture reported on China Antimicrobial Resistance Surveillance System (CARSS) from 2014 to 2019 was analyzed. Results A total of 1 599 273 strains of bacteria were isolated from blood specimens, including 828 846 strains (51.8%) of Gram-negative bacteria. The top 5 pathogens didn't change from 2014 to 2019, the first was Escherichia coli (402 818 strains, 25.2%), followed by Staphylococcus epidermidis (193 968 strains, 12.1%), Klebsiella pneumoniae (162 613 strains, 10.2%), Staphylococcus hominis (136 396 strains, 8.5%) and Staphylococcus aureus (106 915 strains, 6.7%). Among non-fermentative bacteria, Pseudomonas aeruginosa (43 565 strains, 2.7%) and Acinetobacter baumannii (37 244 strains, 2.3%) had the highest isolation rates, but showed a downward trend year by year. Resistance rates of Escherichia coli to carbapenems ranged from 0.8% to 1.6%, and to meropenem increased from 0.8% to 1.3%. Resistance rates of Klebsiella pneumoniae to imipenem and meropenem increased, which were 6.6%-11.7%. Resistance rate of Pseudomonas aeruginosa to imipenem decreased, resistance rate to amikacin decreased from 7.1% to 2.6%. Resistance rate of Acinetobacter baumannii to carbapenems decreased. Vancomycin-, linezolid- and teicoplanin-resistant Staphylococcus spp. was not found. Resistance of Enterococcus to vancomycin, teicoplanin and linezolid were all low. Conclusion Gram-negative bacilli are the most common clinical pathogens from blood specimens in China, there is no significant change in the constituent of species of pathogens. Isolation rate of carbapenem-resistant Klebsiella pneumoniae increased, isolation rates of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii decreased, it is necessary to strengthen surveillance on antimicrobial resistance of pathogens causing bloodstream infection and use antimicrobial agents rationally.