# Epidemiology of Healthcare-Associated Infections Caused by Multidrug-Resistant Bacteria and Antimicrobial Resistance Patterns in a Romanian Tertiary Care Hospital

## TL;DR

This study examines the spread and resistance patterns of multidrug-resistant bacteria in a Romanian hospital, finding high mortality and resistance rates in intensive care units.

## Contribution

The study provides a detailed epidemiological and microbiological analysis of MDR-related HAIs in a Romanian tertiary hospital over four semesters.

## Key findings

- 17.13% of HAIs were caused by MDR bacteria, with Acinetobacter baumannii and Klebsiella spp. being the most common.
- Resistance rates to ciprofloxacin, cefepime, and ceftazidime exceeded 95%, and carbapenem resistance surpassed 90%.
- High mortality (51.79%) was observed among MDR-HAI patients, especially those infected with A. baumannii and K. pneumoniae.

## Abstract

Background/Objectives: Healthcare-associated infections (HAIs), particularly those caused by multidrug-resistant (MDR) bacteria, remain a major challenge for Romanian hospitals. This study aimed to evaluate the epidemiological burden of MDR-related HAIs and to characterize the distribution of MDR bacterial isolates and their antimicrobial resistance patterns over four consecutive semesters in a Romanian tertiary care hospital. Methods: A retrospective study was conducted using data from the Electronic Registry of HAIs, clinical observation sheets, and microbiology laboratory records. An epidemiological analysis was performed on patients diagnosed with MDR-related HAIs, while a separate microbiological analysis included all MDR bacterial isolates identified during the study period. Descriptive and comparative statistical analyses were applied to assess temporal trends, pathogen distribution, and resistance profiles. Results: Of the 327 HAIs identified, 56 cases (17.13%) were caused by MDR bacteria. Most MDR-HAIs originated from the Intensive Care Unit (≈60%), with Acinetobacter baumannii and Klebsiella spp. as the predominant pathogens. Overall mortality among patients with MDR-HAIs was high (51.79%), particularly in infections caused by A. baumannii and K. pneumoniae. Microbiological analysis of MDR isolates (n = 406) revealed consistently high resistance rates to ciprofloxacin, cefepime, and ceftazidime, exceeding 95% in 2023–2024, while resistance to carbapenems surpassed 90% by the end of the study period. Temporal variability in MDR burden was observed across semesters, suggesting an influence of clinical and institutional factors. Conclusions: MDR-related HAIs represent a significant and persistent problem in Romanian acute-care hospitals, particularly in Intensive Care Units. The dominance of carbapenem-resistant A. baumannii and extended-spectrum beta-lactamase-producing and carbapenem-resistant Klebsiella spp. highlights the urgent need for strengthened antimicrobial stewardship, enhanced microbiological surveillance, and reinforced infection prevention strategies.