{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:15:36Z","timestamp":1787030136345,"version":"build-2736575974"},"reference-count":36,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>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\u2013August 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\u201311.0; 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.<\/jats:p>","DOI":"10.3390\/v17101353","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T07:56:29Z","timestamp":1759996589000},"page":"1353","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Global Burden of Bloodstream Infections in COVID-19: Prevalence, Antimicrobial Resistance, and Mortality Risk"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4951-1702","authenticated-orcid":false,"given":"Diana-Maria","family":"Mateescu","sequence":"first","affiliation":[{"name":"Doctoral School, Department of General Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian-Cosmin","family":"Ilie","sequence":"additional","affiliation":[{"name":"Department of Public Health and Sanitary Management, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana","family":"Cotet","sequence":"additional","affiliation":[{"name":"Doctoral School, Department of General Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Guse","sequence":"additional","affiliation":[{"name":"Doctoral School, Department of General Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3896-9599","authenticated-orcid":false,"given":"Camelia-Oana","family":"Muresan","sequence":"additional","affiliation":[{"name":"Legal Medicine, Timisoara Institute of Legal Medicine, 300041 Timisoara, Romania"},{"name":"Ethics and Human Identification Research Center, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Discipline of Forensic Medicine, Bioethics, Deontology, and Medical Law, Department of Neuroscience, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana-Maria","family":"Pah","sequence":"additional","affiliation":[{"name":"Cardiology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marius","family":"Badalica-Petrescu","sequence":"additional","affiliation":[{"name":"Cardiology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stela","family":"Iurciuc","sequence":"additional","affiliation":[{"name":"Cardiology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria-Laura","family":"Craciun","sequence":"additional","affiliation":[{"name":"Cardiology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7868-9266","authenticated-orcid":false,"given":"Adina","family":"Avram","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Enache","sequence":"additional","affiliation":[{"name":"Legal Medicine, Timisoara Institute of Legal Medicine, 300041 Timisoara, Romania"},{"name":"Ethics and Human Identification Research Center, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Discipline of Forensic Medicine, Bioethics, Deontology, and Medical Law, Department of Neuroscience, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e14","DOI":"10.1016\/S2666-5247(20)30004-5","article-title":"Comparative tropism, replication kinetics, and cell damage profiling of SARS-CoV-2 and SARS-CoV with implications for clinical manifestations, transmissibility, and laboratory studies of COVID-19: An observational study","volume":"1","author":"Chu","year":"2020","journal-title":"Lancet Microbe"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1001\/jama.2020.2648","article-title":"Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72,314 Cases from the Chinese Center for Disease Control and Prevention","volume":"323","author":"Wu","year":"2020","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e13319","DOI":"10.1111\/eci.13319","article-title":"Bloodstream Infections in Critically Ill Patients with COVID-19","volume":"50","author":"Giacobbe","year":"2020","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Pourajam, S., Kalantari, E., Talebzadeh, H., Mellali, H., Sami, R., Soltaninejad, F., Amra, B., Sajadi, M., Alenaseri, M., and Kalantari, F. (2022). Secondary Bacterial Infection in COVID-19 Patients. Front. Cell. Infect. Microbiol., 12.","DOI":"10.3389\/fcimb.2022.784130"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e354","DOI":"10.1016\/S2666-5247(21)00090-2","article-title":"Co-infections, secondary infections, and antimicrobial use in patients hospitalised with COVID-19 during the first pandemic wave from the ISARIC WHO CCP-UK study: A multicentre, prospective cohort study","volume":"2","author":"Russell","year":"2021","journal-title":"Lancet Microbe"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1186\/s13613-021-00971-w","article-title":"Characteristics and Prognosis of Bloodstream Infection in Patients with COVID-19 Admitted in the ICU: An Ancillary Study of the COVIDICU Study","volume":"11","author":"Massart","year":"2021","journal-title":"Ann. Intensive Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2551","DOI":"10.3201\/eid2710.210538","article-title":"Bloodstream Infection Risk, Incidence, and Deaths for Adults Hospitalized with COVID-19","volume":"27","author":"Shukla","year":"2021","journal-title":"Emerg. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.jointm.2023.12.004","article-title":"Bloodstream infections in the era of the COVID-19 pandemic: Changing epidemiology of antimicrobial resistance in the intensive care unit","volume":"4","author":"Ntziora","year":"2024","journal-title":"J. Intensive Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Sleziak, J., B\u0142a\u017cejewska, M., and Duszy\u0144ska, W. (2025). Central Line-Associated Bloodstream Infections in Intensive Care Unit During and After the COVID-19 Pandemic, 5-Year Prospective Observational Study. J. Clin. Med., 14.","DOI":"10.3390\/jcm14165655"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"S\u0142abisz, N., Dudek-Wicher, R., Le\u015bnik, P., Majda, J., Kujawa, K., and Nawrot, U. (2023). Impact of the COVID-19 Pandemic on the Epidemiology of Bloodstream Infections in Hospitalized Patients\u2014Experience from a 4th Military Clinical Hospital in Poland. J. Clin. Med., 12.","DOI":"10.3390\/jcm12185942"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1186\/s13054-022-04166-y","article-title":"Different epidemiology of bloodstream infections in COVID-19 compared to non-COVID-19 critically ill patients: A descriptive analysis of the Eurobact II study","volume":"26","author":"Buetti","year":"2022","journal-title":"Crit. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Leitl, C.J., Stoll, S.E., Wetsch, W.A., Kammerer, T., Mathes, A., B\u00f6ttiger, B.W., Seifert, H., and Dusse, F. (2023). Next-Generation Sequencing in Critically Ill COVID-19 Patients with Suspected Bloodstream Infections. J. Clin. Med., 12.","DOI":"10.3390\/jcm12041466"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.hrtlng.2023.07.012","article-title":"Bloodstream infections in COVID-19 patients undergoing extracorporeal membrane oxygenation in ICU: An observational cohort study","volume":"62","author":"Carelli","year":"2023","journal-title":"Heart Lung"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Montrucchio, G., Grillo, F., Balzani, E., Gavanna, G., Sales, G., Bonetto, C., Simonetti, U., Zanierato, M., Fanelli, V., and Filippini, C. (2025). Impact of Multidrug-Resistant Bacteria in a Cohort of COVID-19 Critically Ill Patients: Data from a Prospective Observational Study Conducted in a High-Antimicrobial-Resistance-Prevalence Center. J. Clin. Med., 14.","DOI":"10.3390\/jcm14020410"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.ijid.2021.12.349","article-title":"Bloodstream infections in hospitalized patients before and during the COVID-19 surge in a community hospital in the South Bronx","volume":"116","author":"Afzal","year":"2022","journal-title":"Int. J. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e31","DOI":"10.1097\/CCM.0000000000004748","article-title":"Unexpectedly high frequency of enterococcal bloodstream infections in coronavirus disease 2019 patients admitted to an Italian ICU: An observational study","volume":"49","author":"Bonazzetti","year":"2021","journal-title":"Crit. Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e1082","DOI":"10.1093\/cid\/ciab869","article-title":"Changing patterns of bloodstream infections in the community and acute care across two COVID-19 epidemic waves: A retrospective analysis using data linkage","volume":"75","author":"Zhu","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Driedger, M., Daneman, N., Brown, K., Gold, W.L., Jorgensen, S.C.J., Maxwell, C., Schwartz, K.L., Morris, A.M., Thiruchelvam, D., and Langford, B. (2023). The impact of the COVID-19 pandemic on blood culture practices and bloodstream infections. Microbiol. Spectr., 11.","DOI":"10.1128\/spectrum.02630-23"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"253","DOI":"10.18683\/germs.2022.1327","article-title":"Incidence of bloodstream infections in patients with COVID-19: A retrospective cohort study of risk factors and outcomes","volume":"12","author":"Santos","year":"2022","journal-title":"Germs"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Giannitsioti, E., Louka, C., Mamali, V., Kousouli, E., Velentza, L., Papadouli, V., Loizos, G., Mavroudis, P., Kranidiotis, G., and Rekleiti, N. (2022). Bloodstream Infections in a COVID-19 Non-ICU Department: Microbial Epidemiology, Resistance Profiles and Comparative Analysis of Risk Factors and Patients\u2019 Outcome. Microorganisms, 10.","DOI":"10.3390\/microorganisms10071314"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Fallah, F., Karimi, A., Azimi, L., Ghandchi, G., Gholinejad, Z., Abdollahi, N., AhariOskooie, N., Khodaei, H., Armin, S., and Behzad, A. (2024). The impact of the COVID-19 pandemic on pediatric bloodstream infections and alteration in antimicrobial resistance phenotypes in Gram-positive bacteria, 2020\u20132022. BMC Pediatr., 24.","DOI":"10.1186\/s12887-024-05146-7"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1017\/ice.2021.108","article-title":"Impact of COVID-19 pandemic on central-line-associated bloodstream infections during the early months of 2020, National Healthcare Safety Network","volume":"43","author":"Patel","year":"2022","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Papic, I., Bistrovic, P., Cikara, T., Busic, N., Keres, T., Ortner Hadziabdic, M., and Lucijanic, M. (2024). Corticosteroid Dosing Level, Incidence and Profile of Bacterial Blood Stream Infections in Hospitalized COVID-19 Patients. Viruses, 16.","DOI":"10.3390\/v16010086"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"159","DOI":"10.3201\/eid3001.230183","article-title":"Increased Peripheral Venous Catheter Bloodstream Infections during COVID-19 Pandemic, Switzerland","volume":"30","author":"Zanella","year":"2024","journal-title":"Emerg. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Lai, H.C., Hsu, Y.L., Lin, C.H., Wei, H.M., Chen, J.A., Low, Y.Y., Chiu, Y.T., Lin, H.C., and Hwang, K.P. (2023). Bacterial coinfections in hospitalized children with COVID-19 during the SARS-CoV-2 Omicron BA.2 variant pandemic in Taiwan. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1178041"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"ofad122","DOI":"10.1093\/ofid\/ofad122","article-title":"Community-Onset Bacterial Coinfection in Children Critically Ill with Severe Acute Respiratory Syndrome Coronavirus 2 Infection","volume":"10","author":"Moffitt","year":"2023","journal-title":"Open Forum Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Cona, A., Tavelli, A., Renzelli, A., Varisco, B., Bai, F., Tesoro, D., Za, A., Biassoni, C., Battaglioli, L., and Allegrini, M. (2021). Incidence, Risk Factors and Impact on Clinical Outcomes of Bloodstream Infections in Patients Hospitalised with COVID-19: A Prospective Cohort Study. Antibiotics, 10.","DOI":"10.3390\/antibiotics10091031"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Ippolito, M., Simone, B., Filisina, C., Catalanotto, F.R., Catalisano, G., Marino, C., Misseri, G., Giarratano, A., and Cortegiani, A. (2021). Bloodstream Infections in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis. Microorganisms, 9.","DOI":"10.3390\/microorganisms9102016"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.jhin.2024.05.013","article-title":"Epidemiology of bloodstream infections caused by extended-spectrum cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae","volume":"150","author":"Damonti","year":"2024","journal-title":"J. Hosp. Infect."},{"key":"ref_31","unstructured":"World Health Organization (2022). Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report 2022, WHO. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240062702."},{"key":"ref_32","unstructured":"World Health Organization (2015). Global Action Plan on Antimicrobial Resistance, WHO. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789241509763."},{"key":"ref_33","unstructured":"European Centre for Disease Prevention and Control (2025, August 29). Antimicrobial Resistance in the EU\/EEA (EARS-Net)\u2014Annual Epidemiological Report 2023, Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/antimicrobial-resistance-eueea-ears-net-annual-epidemiological-report-2023."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Xiao, S., Liang, X., Han, L., and Zhao, S. (2024). Incidence, antimicrobial resistance and mortality of Pseudomonas aeruginosa bloodstream infections among hospitalized patients in China: A retrospective observational multicenter cohort study from 2017 to 2021. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1294141"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e13798","DOI":"10.1111\/myc.13798","article-title":"Candidemia Following Severe COVID-19 in Hospitalised and Critical Ill Patients: A Systematic Review and Meta-Analysis","volume":"67","author":"Srisurapanont","year":"2024","journal-title":"Mycoses"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.ijantimicag.2016.01.015","article-title":"Regional differences and trends in antimicrobial susceptibility of Acinetobacter baumannii","volume":"47","author":"Lob","year":"2016","journal-title":"Int. J. Antimicrob. Agents"}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/10\/1353\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:50:47Z","timestamp":1760035847000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/10\/1353"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,9]]},"references-count":36,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["v17101353"],"URL":"https:\/\/doi.org\/10.3390\/v17101353","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,9]]}}}