OBJECTIVES: There is a dearth of studies in India that quantifies the impact of multidrug resistance on key economic and clinical outcomes. The aim of this retrospective cohort study was to determine the costs of treatment and evaluate the clinical outcomes in patients suffering from multidrug resistant (MDR) Staphylococcus aureus bacteremia and compare these with the costs and clinical outcomes of patients suffering from non-MDR S. aureus bacteremia. METHODS: Data was collected from 2007 through October 2010 from a private tertiary care hospital in India. Multidrug resistance was defined as resistance to ≥3 classes of antimicrobial drugs. Resistance within a class was defined as resistance to ≥1 antimicrobial agent. RESULTS: A total of 42 cases were included in the study of which 19 belonged to the MDR cohort and 23 to the non-MDR cohort The total mean cost for treating patients in the MDR cohort was 1.35 times higher compared to the non-MDR cohort (INR 230,000 [170,000-623,000] vs. INR 171,000 [91,000-310,000]; P = .049). Death was reported in similar number of patients in both the groups (5 patients and 4 patients in the MDR cohort and non-MDR cohort, respectively). The number of deaths attributable to sepsis was also similar between the groups (16% vs 13%). The total mean length of stay in hospital was significantly longer for the MDR cohort compared with non‑MDR cohort (19 days [16-28] vs. 14 days [9.2-18.5]; P = .024). However, after the onset of bacteremia, the difference in the length of stay between the groups was not statistically significant (16 days [14-21] vs. 11 days [8-15.5]; P = .12). CONCLUSIONS: Multidrug resistance in S. aureus bacteremia was associated with a significant increase in hospital costs.