OBJECTIVES: To assess the impact of infections caused by multidrug-resistant organisms (MDR) on costs and length of stay. This research is a pilot study of the “MDR Impact Program", a nationwide study on the impact of infections by MDR in Brazil, supported by the Brazilian Ministry of Health. METHODS: All patients admitted to the ICU of a Brazilian public hospital in São Paulo/Brazil, from 2016 to 2018 were analyzed (total of 2009 ICU admissions). Absorption Costing Method was used to assess individual patients costs. Patients with central venous catheters were included in the analysis, and classified in two groups: MDR infection (n = 20), and no infection (n = 1964). Non-MDR patients (n = 25) were excluded from the analysis. Propensity score was used to match patient groups based on ICU admission variables as age, sex, Charlson Comorbidity index, SAPS3, hospital readmission and year of admission, using nearest neighbor metric. RESULTS: A total of 2009 ICU admissions were studied, resulting in 11 MDR cases and 15 controls. Hospital admissions costs by MDR infections were $ 81,153.98 versus $ 18,736.68 in controls ($ 62,417.30 of incremental costs per patient). LOS was 59.45 days in MDR group versus 15.20 days in control (incremental LOS per patient of 44.25 days). Considering the 11 paired cases the total incremental cost was $ 686,590.26 and the incremental LOS was 486.75 days. CONCLUSIONS: Expressive incremental costs associated with MDR infection are as high as 115% of paired admissions without infections. Each infection avoided could generate $ 1,410.56 per patient daily savings. The patient with MR infection costs has a potential economy de $ 1,410.56 more per day of hospitalization avoided.