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This research aimed to assess the impact of secondary bacterial pneumonia on outcomes in octogenarians with COVID-19.

January 14, 2026Microorganisms0 citationsOpen Access

Respiratory and Pleural Pathogens in Octogenarians Hospitalized with COVID-19: Impact of Secondary Bacterial Pneumonia on Day-5 SOFA and Mortality

PDPetrinela DaliuVictor Babeș University of Medicine and Pharmacy Timișoara FBFelix BratosinVictor Babeș University of Medicine and Pharmacy Timișoara OROvidiu RoscaVictor Babeș University of Medicine and Pharmacy Timișoara

Key Points

This research aimed to assess the impact of secondary bacterial pneumonia on outcomes in octogenarians with COVID-19.
Retrospective cohort study of adults with COVID-19 at a tertiary care center
Used RT-PCR to confirm cases and processed respiratory samples via EUCAST standards
Identified pathogens using MALDI-TOF MS and analyzed associations with day-5 SOFA/APACHE II and mortality
In octogenarians, incidence of secondary pneumonia significantly increased day-5 SOFA scores
Higher mortality observed in those with pneumonia at 37.5% compared to 9.8% in younger adults
Predominant pathogens included Streptococcus pneumoniae and methicillin-resistant Staphylococcus aureus

Abstract

Background and Objectives: Secondary bacterial infection drives poor outcomes in older adults with COVID-19, but age-specific microbiology and its interaction with severity scores are not well defined. We characterized respiratory and pleural pathogens, resistance profiles, and their impact on day-5 SOFA/APACHE II in octogenarians versus younger adults. Methods: We performed a retrospective cohort study of adults with RT-PCR-confirmed coronavirus disease 2019 (COVID-19) at a tertiary infectious diseases center (≥80 years, n = 152; <65 years, n = 327). Respiratory and pleural samples were processed according to EUCAST standards. Identification employed matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Pathogen distributions, susceptibilities, and rates of superimposed pneumonia, empyema, and bacteremia were compared by age, and associations between secondary pneumonia, day-5 SOFA/APACHE II, and 28-day mortality were analyzed. Results: Sputum was obtained in 67.1% of older and 65.7% of younger adults, with numerically higher culture positivity in older patients (73.5% vs. 65.1%). Pathogen spectra were similar, dominated by Streptococcus pneumoniae (24.0% vs. 24.3%), methicillin-susceptible Staphylococcus aureus (MSSA) (18.7% vs. 20.7%), methicillin-resistant Staphylococcus aureus (MRSA) (9.3% vs. 6.4%), and Klebsiella pneumoniae, including extended-spectrum β-lactamase (ESBL)-producing strains. Empyema was more frequent in octogenarians (7.9% vs. 3.1%), and pleural cultures were usually positive. Meropenem retained 100% activity against ESBL-producing K. pneumoniae and Pseudomonas in both strata. In ≥80-year-olds, superimposed pneumonia was associated with higher day-5 SOFA (6.6 vs. 5.5) and APACHE II (24.3 vs. 21.0) scores and markedly increased 28-day mortality (37.5% vs. 9.8%). Conclusions: In octogenarians with COVID-19, secondary bacterial pneumonia and empyema are frequent, microbiologically similar to younger adults, and strongly amplify organ dysfunction and mortality even with largely preserved carbapenem susceptibility.

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