Understanding the burden of multidrug-resistant organisms in neurosurgical care: Resistance trends and risk profiles

Objective: This study aimed to assess the prevalence, resistance patterns, and clinical predictors of MDROs in neurosurgical patients at a tertiary hospital in Oman. Materials and Methods: A retrospective analysis was conducted on 238 patients admitted to the neurosurgical and neurology departments at Khoula Hospital from January to December 2019. Data included demographics, clinical diagnoses, hospital stays, and antimicrobial resistance profiles. Statistical analyses, including Chi-square tests and logistic regression, identified predictors of prolonged hospital stay and high-risk patient groups. Results: Methicillin-resistant Staphylococcus aureus (MRSA, 54.2%) and carbapenem-resistant Enterobacteriaceae (CRE, 34.5%) were the most prevalent MDROs. Resistance was highest against b-lactams (95.4%), sulfonamides (95.4%), and quinolones (91.6%), with no resistance observed to oxazolidinones and lipopeptides. Multidrug resistance and CRE were significant predictors of prolonged length of stay (LOS) ( p < 0.001), and logistic regression identified a high-risk subgroup (10.1%) requiring focused interventions. The predominance of multi-source diagnostics (69%) underscored the importance of comprehensive testing in managing MDRO infections. Conclusion: The study highlights the substantial burden of MDROs in neurosurgical care in Oman, necessitating robust antimicrobial stewardship, targeted interventions, and ongoing surveillance. Future research should focus on multicenter studies to address the growing challenge of antimicrobial resistance.