肺移植受者ICU阶段面临多重耐药菌(MDRO)定值或感染的风险高，该风险不能简单归因于机械通气、导管使用或住院时间较长，应看作是供者微生物、受者术前定植、免疫抑制强度、移植肺气道防御缺陷、支气管吻合状态异常或气道操作频繁等因素共同作用的结果。肺移植术后早期MDRO发生定植或感染的风险较高，下呼吸道为最常见的感染部位，且感染、原发性移植物失功或急性排斥反应三者又常具有相似的临床表现、影像学检查结果及炎症标志物，因而病原学判断与抗菌药物选择较为困难。本文综述肺移植受者ICU阶段MDRO感染的流行病学特征，以及供者、受者和移植肺相关高危因素、下呼吸道病原学监测、定植与感染的鉴别、抗菌药物管理和多学科协作防控等内容；同时提出整合电子病历、微生物学、呼吸支持、免疫抑制、影像学及环境流行病学等资料，结合动态预测、耐药模式、传播链分析和人工智能，展望肺移植MDRO感染的防控策略。

Lung transplant recipients face a substantial risk of multidrug-resistant organisms (MDRO) colonization or infection during their ICU hospitalization. This risk can′t be attributed solely to mechanical ventilation, indwelling catheters, or prolonged length of stay; instead, it should be understood as the consequence of multiple synergistic factors including donor-derived microorganisms, pretransplant recipient colonization, intensity of immunosuppressive therapy, impaired airway defense mechanisms in the transplanted lung, abnormal bronchial anastomotic healing, and frequent airway manipulation procedures. The early post-transplant period carries a heightened risk of MDRO colonization or infection, with the lower respiratory tract being the most common site of infection. Furthermore, infection, primary graft dysfunction, and acute rejection frequently present with overlapping clinical manifestations, imaging findings, and inflammatory biomarkers, thereby complicating both microbiological diagnosis and antimicrobial agent selection. This review synthesizes the epidemiological characteristics of MDRO infections in lung transplant recipients during the ICU phase, encompassing donor-, recipient-, and graft-related risk factors, lower respiratory tract microbiological surveillance, differentiation between colonization and infection, antimicrobial stewardship, and multidisciplinary collaborative prevention and control strategies. Concurrently, it proposes an integrated approach that consolidates data from electronic medical records, microbiology, mechanical respiratory support, immunosuppressive regimens, imaging modalities, and environmental epidemiology. By incorporating dynamic risk prediction, antimicrobial resistance patterns, transmission chain analysis, and artificial intelligence applications, this review outlines future perspectives for MDRO prevention and control strategies in lung transplantation.