{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T14:03:00Z","timestamp":1768226580358,"version":"3.49.0"},"reference-count":27,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babe\u0219 University of Medicine and Pharmacy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>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 (\u226580 years, n = 152; &lt;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 \u03b2-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 \u226580-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.<\/jats:p>","DOI":"10.3390\/microorganisms14010164","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T10:25:23Z","timestamp":1768213523000},"page":"164","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Respiratory and Pleural Pathogens in Octogenarians Hospitalized with COVID-19: Impact of Secondary Bacterial Pneumonia on Day-5 SOFA and Mortality"],"prefix":"10.3390","volume":"14","author":[{"given":"Petrinela","family":"Daliu","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4711-4315","authenticated-orcid":false,"given":"Felix","family":"Bratosin","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"},{"name":"Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8236-2205","authenticated-orcid":false,"given":"Ovidiu","family":"Rosca","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"},{"name":"Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9245-5883","authenticated-orcid":false,"given":"Monica","family":"Licker","sequence":"additional","affiliation":[{"name":"Discipline of Microbiology, Multidisciplinary Research Center of Antimicrobial Resistance, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"},{"name":"Microbiology Laboratory, \u201cPius Brinzeu\u201d County Clinical Emergency Hospital, 300723 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8805-2046","authenticated-orcid":false,"given":"Elena","family":"Hogea","sequence":"additional","affiliation":[{"name":"Discipline of Microbiology, Multidisciplinary Research Center of Antimicrobial Resistance, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Livia","family":"Stanga","sequence":"additional","affiliation":[{"name":"Discipline of Microbiology, Multidisciplinary Research Center of Antimicrobial Resistance, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camelia Vidita","family":"Gurban","sequence":"additional","affiliation":[{"name":"Department IV Biochemistry and Pharmacology, Discipline of Biochemistry, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9100-4530","authenticated-orcid":false,"given":"Delia","family":"Muntean","sequence":"additional","affiliation":[{"name":"Discipline of Microbiology, Multidisciplinary Research Center of Antimicrobial Resistance, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"do Nascimento Silva, D., de Sousa Mata, \u00c1.N., de Medeiros, G.C.B.S., Marques, M.V., dos Santos, T.T., de Sousa Monteiro, M.T., Costa, G.G., d\u2019Orsi, E., Parra, E.V., and Piuvezam, G. 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