Risk Factors and Antibiotic Utilization Patterns in Multidrug-Resistant Surgical Infections: A Retrospective Study From a Romanian Tertiary-Care Center.

Background: Multidrug-resistant (MDR) infections represent a major challenge in surgical patients, particularly in settings with prolonged hospitalization and intensive care exposure. Identifying risk factors and their impact on mortality is essential for optimizing antimicrobial stewardship and infection control strategies. Methods: We conducted a retrospective observational study including surgical patients admitted to a Romanian tertiary-care hospital between 2020 and 2022. Demographic, clinical, microbiological, and antibiotic utilization data were analyzed using multivariate logistic regression and receiver operating characteristic (ROC) curve analysis to identify factors associated with MDR infection and in-hospital mortality. Results: Prolonged intensive care unit (ICU) stay and longer hospitalization were the main independent predictors of MDR infection. Antibiotic prophylaxis was also associated with MDR status, likely reflecting increased antimicrobial exposure in high-risk patients, while a higher comorbidity burden showed an inverse association. MDR infections were strongly associated with increased in-hospital mortality and remained an independent predictor after adjustment, alongside ICU stay and older age. MDR cases were characterized by more frequent use of broad-spectrum antibiotics, whereas non-MDR patients more commonly received narrower-spectrum regimens. The most frequent MDR pathogens included Conclusions: MDR infections in surgical patients are primarily driven by prolonged healthcare exposure, particularly ICU admission and extended hospitalization. These findings highlight the importance of targeted infection control measures and optimized antimicrobial use to reduce mortality and limit the spread of resistance.