Abstract: OBJECTIVE To investigate the distribution of the elderly hospitalized patients with multidrug-resistant organisms (MDROs) infections and analyze the specimen sources so as to provide bases for formulating more effective prevention and control programs for MDROs. METHODS The MDROs that were isolated from the elderly patients with no less than 65 years of age who were treated in Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University) from Jan. 2020 to Dec. 2024 were retrospectively investigated. The composition of MDROs and distribution of infection sources were observed. RESULTS A total of 8009 strains of MDROs were isolated from the hospital between Jan. 2020 to Dec. 2024, of which 2941 (36.72%) were isolated from the elderly patients, and 65.96% of the strains were isolated from respiratory tract specimens. The strains were mainly isolated from ICUs, accounting for 65.32%; the isolation rates of CRAB, CRKP and MRSA were highest in the ICUs of respiratory medicine department, followed by the general ICUs. Among the non-ICU departments, the MDROs were mainly isolated from the hepatobiliary surgery department, both CREC and VRE ranked the first place. Among the strains, 62.80% were acquired outside the hospital, and the constituent ratios of the total strains causing health care-associated infections (HAIs) showed a descending trend from 2020 to 2024, with the different statistically significant (Z=-5.961,χ²=35.533,P＜0.001); the constituent ratios of MDROs causing the HAIs varied slightly in the ICUs, among which CRAB and CRKP were dominant. The strains were mainly isolated from the respiratory tract specimens and blood specimens. CONCLUSIONS The elderly patients of ICUs are dominant among the patients with MDROs infections, most of whom were acquired outside the hospital. It is necessary to attach great importance to the sources of MDROs infections, carry out the targeted prevention and control based on the characteristics of sources of MDROs infections from the ICUs, and intensify the implementation of prevention and control measures for MDROs infections through joint prevention and control.