Introduction: Multidrug-resistant organisms (MDRO) cause significant morbidity and mortalityin hospitalised patients, particularly true in paediatric oncology units, especially in low- andmiddle-income countries. Objectives: To study the microbiological spectrum and outcomes of children onchemotherapy with MDRO sepsis. Methods: Retrospective chart review of all children with blood culture-proven MDRO sepsis diagnosed between October 2017 and August 2025 was performed. Results: During the study period, 574 children on chemotherapy had total of 1886 febrile episodes. Of these, 324 episodes were blood culture-positive sepsis (Gram positive cocci (GPC) -130 (40%), GNB – 171 (52.77%), Fungi – 21 (6.5%). Among the 171 gram-negative sepsis, 64 were MDRO (37 .42%), including 35 multidrug resistant, 28 extreme-drug resistant, and 1 pan-drug resistant organisms. The most common GNB-MDRO was Klebsiella pneumoniae (n=24, 37 .5%). Hemodynamic instability , intensive care requirement seen in 43 (67 .2%), 32 (50%) respectively . Nearly a third i.e., 22 (34.37%) developed multi-organ dysfunction (MODS), and a quarter, 17 (26.56%) succumbed to MODS. Among the 130 episodes of GPC sepsis, 86 (66.15%) were coagulase-negative staphylococcus (CONS). Nearly two-thirds of CONS i.e., 52 (60.5%) and half of staphylococcus aureus i.e., 7 (43.75%) were methicillin-resistant. 7 (63.6%) of enterococcus infections were vancomycin resistant. Among them, Intensive care, inotropic support required in 25 (37 .87%),20 (30.3%). 8 (12.12%) developed MODS, and all 8 (12.12%) succumbed. Conclusion: MDRO contributes significantly to morbidity and mortality in paediatric oncology units. Nearly half of those with MDRO-GNB & a third of those with GPC-MDRO require intensive care, with 26% and 12% mortality , respectively .