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.