The presence of multidrug-resistant organisms (MDROs) results in increased morbidity and mortality, prolonged hospital stays, use of alternative drugs, and higher healthcare costs. This is a public health problem that was exacerbated during the COVID-19 pandemic. According to the CDC (USA), more than 2.8 million MDRO infections occur in the United States, and more than 35,000 people die annually as a result, in addition to increased healthcare expenditures and productivity losses. To evaluate the correlation between deaths and multidrug-resistant organisms (MDROs) in patients with Healthcare-Associated Infections (HAIs) in a General Hospital in São Paulo, from May 2020 to June 2025. Observational study of the case-fatality rate in patients with HAIs based on ANVISA/COVISA criteria, caused by MDROs in patients hospitalized in a general hospital in São Paulo from May 2020 to June 2025, through retrospective analysis of data from the database of the Healthcare-Associated Infection Control Service. MDROs were defined as Gram-negative organisms resistant to carbapenems and/or cephalosporins, Gram-positive organisms resistant to oxacillin, and vancomycin-resistant enterococci. A total of 2,377 Healthcare-Associated Infections were analyzed, of which 946 had identified organisms, corresponding to cultures from 895 patients with a known outcome (discharge or death). Patients transferred to other institutions were excluded. In 2020 and 2021, the hospital was exclusively dedicated to the care of patients with COVID-19, and from 2022 onward it assumed the role of a general hospital. Of the 895 patients with HAIs with laboratory-confirmed organisms, 596 (67%) died, and among these, 363 (60.9%) had infections caused by MDROs. Among the 299 patients who were discharged, 161 (53.8%) had MDRO infections and 138 (46.2%) did not. The distribution of HAI-related deaths associated with the presence of MDROs over the entire period (2020–2025) was 81% in 2020, 70% in 2021, 56% in 2022, 49% in 2023, 56% in 2024, and 66% in 2025. High case-fatality was observed among patients with HAIs and MDROs, especially in 2020–2021, a period during which COVID-19 was present among comorbidities. The data demonstrate increased severity of HAIs in the presence of comorbidities and antimicrobial resistance, resulting in increased case-fatality.
Correa et al. (2026) studied this question.