The Resistant Threat in Critical Care: Comprehensive Mapping of the Burden and Outcomes of Multidrug-Resistant Infections in ICU Patients

Background: Multidrug-resistant organism (MDRO) infections are increasingly prevalent in intensive care units (ICUs), posing significant therapeutic and prognostic challenges. Data from low- and middle-income countries remain limited despite carrying a disproportionate global burden. Objectives: To estimate the prevalence of MDRO infections in ICU patients, assess their impact on mortality and clinical outcomes, and identify predictors of infection and death. Methods: This prospective, observational cohort study was conducted over 18 months in a tertiary-care ICU. Adult patients (≥18 years) with culture-positive bacterial infections were enrolled (N=327). MDR status was defined according to CDC/ECDC criteria. Demographics, comorbidities, APACHE II/SOFA scores, device use, and microbiological data were collected. Outcomes included ICU mortality, length of ICU/hospital stay, ventilator days, and complications. Statistical analysis employed Chi-square and t-tests for group comparisons, Kaplan–Meier survival analysis, and multivariate logistic regression to identify predictors of MDR acquisition and mortality. Results: Of 327 patients, 146 (44.6%) had MDRO infections. Gram-negative pathogens predominated: Acinetobacter baumannii (28.1%), Klebsiella pneumoniae (24.7%), and Pseudomonas aeruginosa (19.2%). Carbapenem resistance was alarmingly high in Acinetobacter (89.5%) and Klebsiella (76.3%). Compared to non-MDR infections, MDRO infections were associated with higher ICU mortality (47.9% vs. 28.2%, p