Abstract: Objective To explore the distribution of pathogenic microorganisms and the risk factors for multidrug-resistant organism (MDRO) infections in patients in the Emergency Intensive Care Unit (EICU). Methods Pathogen specimen results were collected from 2 463 patients who were admitted to the EICU of the Affiliated Hospital of Xuzhou Medical University from January 2022 to December 2023 and retrospective analysis was conducted. The distribution of pathogens was analyzed. According to inclusion and exclusion criteria, 169 patients were included in the MDRO infection group, and 338 patients were included in the non-MDRO infection group, using the propensity score matching method at a ratio of 1∶2. Clinical data were collected, while univariate and multivariate logistic regression analyses were performed to identify the risk factors for MDRO infections. Results Among the 2 463 patients, 174 (7.06%) had MDRO infections. A total of 2 098 strains of "five categories and seven species" key monitoring bacteria were isolated. Of these, 1 816 strains (86.6%) were gram-negative bacteria, including 879 strains of Acinetobacter baumannii (41.9%), 493 strains of Klebsiella pneumoniae (23.5%), and 314 strains of Pseudomonas aeruginosa (15.0%); 282 strains (13.4%) were gram-positive bacteria, including 222 strains of Staphylococcus aureus (10.6%). Among the MDROs, 1 214 strains (57.9%) were multidrug-resistant, including 811 strains of carbapenem-resistant Acinetobacter baumannii (66.8%), 164 strains of methicillin-resistant Staphylococcus aureus (13.5%), 128 strains of carbapenem-resistant Klebsiella pneumoniae (10.5%), and 101 strains of carbapenem-resistant Pseudomonas aeruginosa (8.3%). There were no statistically significant differences in age, sex, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, and underlying diseases between the MDRO infection group and the non-MDRO infection group (P>0.05). Univariate analysis showed statistical differences in consciousness disturbance, source of the patients, mechanical ventilation mode, and use of corticosteroids between the two groups (P<0.05). Multivariate logistic regression analysis revealed that treatment in an outside hospital for ≥48 h before admission, consciousness disturbance, and invasive mechanical ventilation were independent risk factors for MDRO infections (P<0.05). Conclusions Treatment in an outside hospital for ≥48 h before admission, consciousness disturbance, and invasive mechanical ventilation increase the risk of MDRO infections in patients in the EICU. For high-risk patients with MDRO infections, active, bundled prevention and intervention measures should be implemented to reduce the incidence and mortality of MDRO infections.