{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T06:02:04Z","timestamp":1785391324363,"version":"3.55.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multidrug-resistant organism (MDRO) infections remain a major cause of healthcare-associated morbidity in intensive care units (ICUs). Local characterization of pathogen profiles and clinical factors associated with MDRO infection is needed to inform infection prevention and antimicrobial stewardship strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective observational study included consecutive adult ICU admissions from January to December 2025 with an ICU length of stay \u226548\u202fh and available microbiological cultures. MDRO infection was defined according to clinical infection criteria and phenotypic non-susceptibility to at least one agent in \u22653 antimicrobial categories. A 1:2 propensity score matching approach was used to reduce baseline imbalance. Univariable and multivariable logistic regression analyses were performed to identify pre-index clinical factors associated with MDRO infection, and model discrimination was assessed using receiver operating characteristic (ROC) analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 986 eligible patients, 103 developed MDRO infection, yielding an incidence of 10.4%, with a median onset of 6\u202fdays after ICU admission. MDRO infections were mainly ventilator-associated\/hospital-acquired pneumonia and bloodstream infection. Carbapenem-resistant\n                      <jats:italic>Acinetobacter baumannii<\/jats:italic>\n                      , carbapenem-resistant Enterobacterales, and carbapenem-resistant\n                      <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                      were the predominant phenotypes. In the matched cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f309), pre-index clinical factors independently associated with MDRO infection included Acute Physiology and Chronic Health Evaluation II score (adjusted odds ratio [aOR] 1.04), pre-ICU antibiotic exposure (aOR 1.58), pre-index ICU carbapenem exposure (aOR 1.92), total pre-index systemic antibiotic duration in ICU (aOR 1.11 per day), pre-index mechanical ventilation (aOR 2.06), pre-index continuous renal replacement therapy (aOR 1.69), procalcitonin (aOR 1.39), and albumin (aOR 0.93). The model showed good discrimination, with an area under the ROC curve of 0.836 and a bootstrap-corrected value of 0.821.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MDRO infections occurred in approximately one-tenth of ICU admissions and were primarily Gram-negative respiratory and bloodstream infections. Illness severity, pre-index antimicrobial exposure intensity and duration, pre-index organ support, and early inflammatory or nutritional biomarkers were independently associated with MDRO infection. These findings may support preliminary ICU risk stratification, but prospective validation and formal time-dependent exposure assessment are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1821168","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T05:40:40Z","timestamp":1785390040000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pathogen characteristics and pre-index clinical factors associated with multidrug-resistant organism infections in intensive care unit patients"],"prefix":"10.3389","volume":"14","author":[{"given":"Xiao-Ju","family":"Ma","sequence":"first","affiliation":[{"name":"Department of Healthcare-Associated Infection Control, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng-Ning","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Healthcare-Associated Infection Control, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1097\/mcc.0000000000000535","article-title":"New guidelines for hospital-acquired pneumonia\/ventilator-associated pneumonia: USA vs. Europe","volume":"24","author":"Martin-Loeches","year":"2018","journal-title":"Curr Opin Crit Care"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e0020623","DOI":"10.1128\/msystems.00206-23","article-title":"Intensive care unit sinks are persistently colonized with multidrug resistant bacteria and mobilizable, resistance-conferring plasmids","volume":"8","author":"Diorio-Toth","year":"2023","journal-title":"mSystems"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1016\/j.jointm.2023.11.007","article-title":"Risk factors and mortality rates of carbapenem-resistant gram-negative bacterial infections in intensive care units","volume":"4","author":"Kuloglu","year":"2024","journal-title":"J. Intens. Med."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"700","DOI":"10.3390\/antibiotics14070700","article-title":"Evaluation of infections caused by Carbapenem-resistant Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae in an intensive care unit: a retrospective study","volume":"14","author":"Kerimoglu","year":"2025","journal-title":"Antibiotics (Basel)."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"926","DOI":"10.3390\/antibiotics14090926","article-title":"Burden of healthcare-associated infections and antimicrobial resistance in a Romanian cardiovascular and transplant center: factors associated with mortality","volume":"14","author":"Budianu","year":"2025","journal-title":"Antibiotics (Basel)"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1376513","DOI":"10.3389\/fpubh.2024.1376513","article-title":"Carbapenem-resistant gram-negative bacteria (CR-GNB) in ICUs: resistance genes, therapeutics, and prevention\u2014a comprehensive review","volume":"12","author":"Li","year":"2024","journal-title":"Front Public Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1186\/s13613-025-01605-1","article-title":"Spectrum, dose, and duration of antibiotic exposure and risk of intensive care unit-acquired carbapenem-resistant gram-negative bacteria: a prospective cohort study","volume":"15","author":"Chen","year":"2025","journal-title":"Ann Intensive Care"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1177\/08850666241290468","article-title":"A retrospective closed cohort study on distribution of multidrug-resistant bacteria in ventilator-associated pneumonia and its impact on patient outcome","volume":"40","author":"Mantri","year":"2025","journal-title":"J Intensive Care Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"20719","DOI":"10.1038\/s41598-025-07820-x","article-title":"Risk factors for multidrug resistant and carbapenem resistant Pseudomonas aeruginosa bloodstream infections among inpatients in central and East China","volume":"15","author":"Xiao","year":"2025","journal-title":"Sci Rep"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"884","DOI":"10.3390\/antibiotics14090884","article-title":"Risk factor analysis of CRE infections at different anatomical sites in ICU patients","volume":"14","author":"Tang","year":"2025","journal-title":"Antibiotics"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1220","DOI":"10.3390\/medicina61071220","article-title":"Microbial multidrug-resistant organism (MDRO) mapping of intensive care unit infections","volume":"61","author":"Yassin","year":"2025","journal-title":"Medicina (Kaunas)"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1658683","DOI":"10.3389\/fphys.2025.1658683","article-title":"Analysis of the etiological characteristics of multidrug-resistant organisms and prognostic factors in ICU patients","volume":"16","author":"Du","year":"2025","journal-title":"Front Physiol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1090","DOI":"10.3390\/antibiotics14111090","article-title":"Profile of multidrug-resistant bacteria in intensive care units of a maternal and child hospital in Rio de Janeiro, Brazil","volume":"14","author":"de Oliveira Villar","year":"2025","journal-title":"Antibiotics (Basel)"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1016\/j.cmi.2021.01.004","article-title":"Methodological quality of studies evaluating the burden of drug-resistant infections in humans due to the WHO global antimicrobial resistance surveillance system target bacteria","volume":"27","author":"Pezzani","year":"2021","journal-title":"Clin Microbiol Infect"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"S70","DOI":"10.1093\/cid\/ciad224","article-title":"Using colonization to understand the burden of antimicrobial resistance across low- and middle-income countries","volume":"77","author":"Styczynski","year":"2023","journal-title":"Clin Infect Dis"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"100063","DOI":"10.1016\/j.aicoj.2026.100063","article-title":"Early trajectories of antibiotic exposure and colonization pressure and risk of ICU-acquired carbapenem-resistant gram-negative bacteria: a prospective cohort study","volume":"16","author":"Chen","year":"2026","journal-title":"Ann Intensive Care"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"277","DOI":"10.5114\/ait.2024.146641","article-title":"Prevalence of multidrug-resistant organisms in intensive care unit patients and rate of subsequent bacteraemia: a 5-year study","volume":"56","author":"Ramachandran","year":"2024","journal-title":"Anaesthesiol Intensive Ther"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e330","DOI":"10.1017\/ash.2025.10244","article-title":"Impact of institutional treatment guidance on the management and outcomes of Stenotrophomonas maltophilia and carbapenem-resistant Acinetobacter baumannii infections","volume":"5","author":"Vathy","year":"2025","journal-title":"Antimicrob Steward Healthc Epidemiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"ciae403","DOI":"10.1093\/cid\/ciae403","article-title":"Infectious diseases society of America 2024 guidance on the treatment of antimicrobial-resistant gram-negative infections","author":"Tamma","year":"2024","journal-title":"Clin Infect Dis"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1016\/j.jiac.2023.06.008","article-title":"Risk factors of multidrug-resistant bacteria infection in patients with ventilator-associated pneumonia: a systematic review and meta-analysis","volume":"29","author":"Hu","year":"2023","journal-title":"J Infect Chemother"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"dlaf022","DOI":"10.1093\/jacamr\/dlaf022","article-title":"Carbapenem de-escalation as an antimicrobial stewardship strategy: a narrative review","volume":"7","author":"Gardner","year":"2025","journal-title":"JAC Antimicrob Resist"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1186\/s12882-025-04272-3","article-title":"Infections and mortality in ICU patients undergoing continuous renal replacement therapy: a retrospective cohort study","volume":"26","author":"Quickfall","year":"2025","journal-title":"BMC Nephrol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1186\/s13054-023-04677-2","article-title":"Procalcitonin-guided antibiotic therapy may shorten length of treatment and may improve survival-a systematic review and meta-analysis","volume":"27","author":"Papp","year":"2023","journal-title":"Crit Care"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1186\/s12879-025-10962-y","article-title":"Carbapenem De-escalation in urinary tract infections: prevalence and outcomes among hospitalized patients","volume":"25","author":"Abuelshayeb","year":"2025","journal-title":"BMC Infect Dis"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.ijid.2019.04.034","article-title":"Clinical outcomes of carbapenem de-escalation regardless of microbiological results: a propensity score analysis","volume":"85","author":"Sadyrbaeva-Dolgova","year":"2019","journal-title":"Int J Infect Dis"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"2782","DOI":"10.3390\/healthcare13212782","article-title":"Evidence-based practices to prevent ventilator-associated pneumonia in an intensive care unit in Bangladesh","volume":"13","author":"Akhter","year":"2025","journal-title":"Healthcare (Basel)"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1089\/respcare.13102","article-title":"2024 year in review: ventilator-associated pneumonia","volume":"70","author":"Ring","year":"2025","journal-title":"Respir Care"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1429443","DOI":"10.3389\/fcimb.2024.1429443","article-title":"Environmental contamination with carbapenem resistant Acinetobacter baumannii in healthcare settings in Fiji: a potential source of infection","volume":"14","author":"Baleivanualala","year":"2024","journal-title":"Front Cell Infect Microbiol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"2024","DOI":"10.3389\/fmicb.2024.1519906","article-title":"An integrative review on the risk factors, prevention, and control strategies for carbapenem-resistant Acinetobacter baumannii colonization in critically ill patients","volume":"15","author":"Zhang","year":"2025","journal-title":"Front Microbiol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1795","DOI":"10.12998\/wjcc.v10.i6.1795","article-title":"Multidrug-resistant organisms in intensive care units and logistic analysis of risk factors","volume":"10","author":"Han","year":"2022","journal-title":"World J Clin Cases"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"15282","DOI":"10.1038\/s41598-023-42522-2","article-title":"Risk predict model using multi-drug resistant organism infection from neuro-ICU patients: a retrospective cohort study","volume":"13","author":"Jiang","year":"2023","journal-title":"Sci Rep"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"110028","DOI":"10.1016\/j.compbiomed.2025.110028","article-title":"Machine learning prediction models for multidrug-resistant organism infections in ICU ventilator-associated pneumonia patients: analysis using the MIMIC-IV database","volume":"190","author":"Cui","year":"2025","journal-title":"Comput Biol Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"2255","DOI":"10.2147\/idr.S459830","article-title":"Machine learning-based prediction model for multidrug-resistant organisms infections: performance evaluation and interpretability analysis","volume":"18","author":"Zhao","year":"2025","journal-title":"Infect Drug Resist."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"3917","DOI":"10.2147\/idr.S412669","article-title":"Microbiological analysis and mortality risk factors in patients with Polymicrobial bloodstream infections","volume":"16","author":"Xu","year":"2023","journal-title":"Infect Drug Resist"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1080\/14767058.2020.1732342","article-title":"Literature review on the distribution characteristics and antimicrobial resistance of bacterial pathogens in neonatal sepsis","volume":"35","author":"Wang","year":"2022","journal-title":"J Matern Fetal Neonatal Med"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1821168\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T05:40:41Z","timestamp":1785390041000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1821168\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,30]]},"references-count":35,"alternative-id":["10.3389\/fpubh.2026.1821168"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1821168","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,30]]},"article-number":"1821168"}}