Background and Aim: Coronaviruses are dangerous human and animal pathogens. This study aimed to determine the prevalence of laboratory proven blood stream bacterial co-infection in hospitalized adult COVID-19 Egyptian patients and to recognize antibiotic susceptibilities of identified pathogens together with evaluation of predictors for case severity.Methods: The study involved 142 adult COVID-19 Egyptian patients. The diagnosis was confirmed by quantitative or real time polymerase chain reaction (PCR) on nasopharyngeal swabs. For each case two blood cultures were taken after ≥ 3 days of admission to detect hospital acquired infections. Results:About 30% of positive blood cultures showed Gram positive staphylococci while Gram negative bacilli were detected by 70% (Klebsiella ;30%, E.coli ; 20% and Pseudomonas ; 20%). Variable resistance patterns were noticed in all bacterial isolates. Hospital acquired blood stream infections (BSI) were identified in 40 cases (28%). The mean age significantly associated with BSI was 63.5±18.2 years old. Hypertension and diabetes had high significant association with BSI by 55% and 60% respectively. Significantly 68% of mechanically ventilated COVID cases were BSI complicated. Death was the fate of 57.5% of BSI positive COVID cases significantly with low O2 saturation and prolonged hospital stay (21.6±3.52 days). Conclusion: All nosocomial blood stream bacterial pathogens were multidrug resistant. Infections were detected among old aged, diabetic, hypertensive and mechanically ventilated patients. Prescribing antibiotics in COVID patients should be guided by careful clinical and laboratory assessment to improve their management and outcomes.