Bring a large pot of salted water to a boil. Cook pasta according to package directions until just al dente, about 8 to 9 minutes for elbow macaroni. Drain and set aside.

Heat a large skillet over medium heat. Add chopped bacon and cook for 6 to 8 minutes until crispy and golden, stirring occasionally. Remove with a slotted spoon onto a paper towel-lined plate. Leave the bacon grease in the skillet.

Add chopped onion to the same skillet over medium heat. Saute for 3 to 4 minutes until soft and translucent. Stir in minced garlic and cook for 30 seconds until fragrant. Do not let the garlic brown.

Add ground beef to the skillet. Break into small pieces and cook over medium-high heat for 5 to 7 minutes until fully browned with no pink remaining. Drain excess fat if needed, leaving a small amount for richness.

Stir in tomato sauce, salt, pepper, Italian seasoning, and Worcestershire sauce. Reduce heat to medium-low and simmer for 5 minutes until the sauce thickens slightly and coats the back of a spoon.

Add the drained pasta to the skillet and stir until evenly combined. If the mixture is too thick, add beef broth or water a few tablespoons at a time until saucy.

Remove skillet from heat. Stir in shredded cheddar cheese in batches, stirring between each addition until fully melted and creamy. Fold in most of the crispy bacon, reserving a handful for topping.

Scoop into bowls. Top with reserved bacon and extra shredded cheese if desired. Serve immediately while hot.