Background: Bacterial and fungal co-infection MESHD has been reported in patients with COVID-19 MESHD, but there is limited experience on these infections in critically ill MESHD patients.Aim: To assess the characteristics and outcome of ICU-acquired infections MESHD in COVID-19 MESHD patients.Methods: In this retrospective single-centre, case-control study, we included 140 patients with severe COVID-19 MESHD admitted to the ICU between March and May 2020. We evaluated the epidemiological, clinical and microbiological features, and outcome of ICU-acquired infections MESHD.Results: Fifty seven patients (40.7%), developed a bacterial or fungal nosocomial infection MESHD during ICU stay. Infection occurred after a median of 9 days (IQR 5-11) of admission, and was significantly associated with the APACHE II score (p=0.02). There were 91 episodes of infection: primary (31%) and catheter-related (25%) bloodstream infections were the most frequent, followed by pneumonia MESHD (23%), tracheobronchitis (10%) and urinary tract infection MESHD (8%), that were produced by a wide spectrum of Gram positive (55%) and Gram negative bacteria (30%) as well as fungi (15%). In 60% of cases, infection was associated with septic shock MESHD, and a significant increase in SOFA score. Overall ICU mortality was 36% (51/140). Infection was significantly associated with death MESHD (OR 2.7, 95% CI 1.2-5.9, p=0.015), and a longer ICU stay (p<0.001).Conclusions: Bacterial and fungal nosocomial infection MESHD is a common complication of ICU admission in patients with COVID-19 MESHD. It usually presents as a severe form of infection and it is associated with a high mortality and longer course of ICU stay.