# Global Burden of Bloodstream Infections in COVID-19: Prevalence, Antimicrobial Resistance, and Mortality Risk

## TL;DR

Bloodstream infections in COVID-19 patients are common, often caused by drug-resistant bacteria, and linked to higher death rates and longer hospital stays.

## Contribution

This study provides the first global meta-analysis of bloodstream infections in confirmed COVID-19 cases, quantifying their prevalence, resistance patterns, and clinical impact.

## Key findings

- Bloodstream infection prevalence was 8.2% in hospitalized COVID-19 patients, with ICU patients having a higher rate of 12.5%.
- Gram-negative bacteria like Klebsiella pneumoniae and Acinetobacter baumannii were the most common pathogens.
- Bloodstream infections were associated with a 2.6-fold increased risk of mortality and longer hospital stays by 6.8 days.

## Abstract

Background: Bloodstream infections (BSIs) complicate COVID-19 inpatients, increasing morbidity, mortality, and healthcare burden. This systematic review and meta-analysis evaluated prevalence, antimicrobial resistance (AMR), risk factors, and outcomes of BSIs in RT-PCR-confirmed COVID-19 cases. Methods: We searched PubMed, Google Scholar, ScienceDirect, and MDPI journals (January 2020–August 2025) following PRISMA 2020 guidelines. Twenty-two observational studies (~123,500 patients, ~602,000 blood cultures) were included: 10 prospective and 12 retrospective. Random-effects models estimated pooled prevalence, odds ratios (ORs), and mean differences, with subgroup analyses (ICU, non-ICU, pediatric) and meta-regression.Results: Pooled BSI prevalence was 8.2% (95% CI: 5.7–11.0; I2 = 50%). Subgroup prevalence was higher in ICU (12.5%) than non-ICU (5.2%) populations. Pediatric cohorts (n = 3) showed a prevalence of 10.8%. Gram-negative pathogens predominated (61%), particularly Klebsiella pneumoniae (26%) and Acinetobacter baumannii (21%). AMR rates were 36% for MRSA and 31% for ESBL-producing Enterobacterales. Risk factors included mechanical ventilation (OR: 2.6), immunosuppression (OR: 2.3), and corticosteroid use (OR: 2.4). BSIs were associated with increased mortality (OR: 2.6), prolonged hospitalization (+6.8 days), and higher ICU admission (OR: 3.1).Conclusions: BSIs, largely driven by multidrug-resistant pathogens, substantially worsen COVID-19 outcomes. Variability in diagnostic criteria (CDC vs. ECDC) and reliance on retrospective designs are limitations, though moderate heterogeneity (I2 = 50%) enhances generalizability across diverse populations. Strengthened infection prevention and antimicrobial stewardship are urgently required.