Sialic acid occupies the terminal position within glycan molecules on the surfaces of many vertebrate cells, where it functions in diverse cellular processes such as intercellular adhesion and cell signalling. Pathogenic bacteria have evolved to use this molecule beneficially in at least two different ways: they can coat themselves in sialic acid, providing resistance to components of the host's innate immune response, or they can use it as a nutrient. Sialic acid itself is either synthesized de novo by these bacteria or scavenged directly from the host. In this mini-review we will summarize recent findings relating to sialic acid transport, modification of sialic acid by O-acetylation, and the mechanisms of sialic acid-mediated complement resistance.