TOPIC: Lung Pathology TYPE: Original Investigations PURPOSE: Steroid use contributes to immunosuppression and subsequent increased risk of infections. During the COVID-19 pandemic, steroid use increased significantly in patients with Acute Respiratory Distress Syndrome (ARDS). The objective of this study is to evaluate the effect of the steroids on rate and type of superimposed nosocomial infections. METHODS: Studies between 12/1/2019 to 3/1/2021 were collected using the following search engines: Cochrane library, Scopus, and Pubmed. A total of 196 studies were collected, which were narrowed to 5 studies. Only randomized clinical trials (RCTs) were included for studies that contain both steroids and COVID-19 infection keywords.The following variables were collected: type and dose of steroids used, mean age, gender, comorbidities, and complications including superimposed infections, type of infection, and mortality rate. A Forest plot was used to demonstrate the date. RESULTS: A total of 7328 patients were included, 2559 patients in the steroids arm and 4769 patients in the control arm.Three studies included sepsis or bacteremia as an outcome, in patients who received steroids; 91 (22%) patients out of 422 patients developed bacteremia or sepsis compared to 99 (24%) patients out of 419 patients in the control arm.In Tomzini, Bruno et al.'s study, bacteremia as a secondary outcome was 7.9% in the steroids (Dexamethasone) arm compared to 9.5% in the control group. In Pierre-François Dequin et al.'s study bacteremia was 6.6% In the steroids group (Hydrocortisone) compared to 11% in the control group. In Prado Jeronimo et al. study, sepsis till day 28 was 38% in the steroids (methylprednisolone) group compared to 39% in the controlled group.Three studies included pneumonia as an outcome with most identified as ventilator-associated pneumonia. In the steroids arm, 50 (15%) patients out of 334 patients had pneumonia, compared to 56 (17%) patients out of 329 in the control arm. CONCLUSIONS: The use of corticosteroids; specifically Hydrocortisone, Dexamethasone and Methylprednisolone, in patients with COVID 19 did not increase the rate of sepsis, bacteremia, or pneumonia in randomized clinical trials published through 3/1/2021. CLINICAL IMPLICATIONS: Although protocolized systems must be used to decrease the rate of nosocomial infections, steroid use in patients with COVID-19 was not associated with an increased risk of bacteremia, sepsis, or pneumonia in the studies reviewed. Further studies need to be done for other nosocomial infections. However, this concern should not prevent clinicians from using steroids in patients with COVID-19, if clinically indicated. DISCLOSURES: No relevant relationships by Shannon Burke, source=Web Response No relevant relationships by Noor Hajjaj, source=Web Response No relevant relationships by Setu Patolia, source=Web Response No relevant relationships by Ahmad Sharayah, source=Web Response No relevant relationships by Mackenzie Steck, source=Web Response