In a large skillet or Dutch oven, cook the bacon until crispy. Remove with a slotted spoon and set aside, leaving about 2 tablespoons of bacon grease in the pan.

Add the ground beef and onion. Cook until the beef is browned and the onion is soft, about 5–7 minutes. Drain excess grease if needed.

Stir in the garlic and cook for 30 seconds. Add the tomato paste, Worcestershire sauce, Dijon mustard, paprika, onion powder, garlic powder, salt, and pepper. Cook for another minute.

Pour in the beef broth and milk, then stir in the uncooked macaroni. Bring to a boil.

Reduce the heat to low, cover, and simmer for 10–12 minutes, stirring occasionally, until the pasta is tender.

Remove from the heat. Stir in the cream cheese until smooth, then mix in the cheddar cheese a handful at a time until melted. Fold in the sour cream, if using.

Stir most of the bacon back into the pasta, reserving a little for the top.

Garnish with the remaining bacon and green onions.