Objective To explore the clinical characteristics and prognostic factors of elderly patients with community-acquired bloodstream infection (CA-BSI), and provide basis for clinical treatment and prevention. Methods Medical records of elderly patients diagnosed with CA-BSI in a tertiary first-class hospital of Changsha from 2017 to 2021 were collected. Patients were divided into a survival group and a death group according to the prognosis after 30 days hospitalization. The differences in clinical data between two groups of patients were compared, and influencing factors for the prognosis in CA-BSI patients were analyzed. Results A total of 575 elderly CA-BSI patients were included in the analysis, with 535 cases in the survival group and 40 cases in the death group. Univariate ana-lysis results suggested that death of elderly CA-BSI patients was related to gender, age, history of hemodialysis, glucocorticoid usage, indwelling catheter, concomitant heart disease, albumin, creatinine, and sequential organ fai- lure assessment (SOFA) score (all P < 0.05). Multivariate logistic regression analysis results suggested that old age (OR=1.062, 95%CI: 1.016-1.109), high SOFA score (OR=1.161, 95%CI: 1.067-1.262), glucocorticoid usage (OR=6.006, 95%CI: 2.441-14.774) were independent risk factors for the death of elderly CA-BSI patients, while normal albumin (OR=0.942, 95%CI: 0.891-0.995) was a protective factor. Conclusion Elderly CA-BSI patients have high risks of death. It is necessary to improve the immunity of patients as well as use antimicrobial agents and glucocorticoids rationally, so as to reduce the risk of death in patients.