Abstract
Multidrug-resistant organisms (MDROs) represent a growing global threat due to resistance to multiple antibiotics, limited treatment options, longer hospitalizations, higher costs, and increased mortality. Although the clinical impact of MDROs is well recognized, their effect on patients' functional recovery remains understudied. This study aimed to determine the prevalence of MDRO infections across hospital settings and examine their association with changes in functional status. A retrospective cohort study analyzed 30 428 adult hospitalizations from 2020 to 2023 in a 294-bed hospital in northern Italy. Demographic data, hospitalization characteristics, MDRO status, and Barthel Index scores at admission and discharge were collected. A multilevel linear regression model examined the effect of MDRO infection on Barthel variation, adjusting for age, sex, discharge area, and length of stay. MDRO infections occurred in 2.4% of hospitalizations (n = 732), mainly in medical and surgical wards, with the highest prevalence in medical and rehabilitation areas. The most common pathogens were ESBL-producing Enterobacteriaceae and vancomycin-resistant enterococci. Patients without MDRO infection showed greater improvement in Barthel scores than those with infection (+3.081; P < .001). Functional improvements were highest in rehabilitation and neurology, whereas medical and surgical wards showed declines. Each additional hospital day was associated with a modest increase in functional independence. Age and sex were not significantly related to functional change. MDRO infections are independently associated with reduced functional recovery, underscoring their clinical and rehabilitative burden and highlighting the need for integrated infection control and early rehabilitation strategies.