SUMMARY Background In Dutch hospitals a 6-point questionnaire is currently mandatory for risk assessment to identify carriers of multidrug-resistant organisms (MDRO) at the time of hospitalization. Presence of one or more risk factors is followed by pre-emptive isolation and microbiological culturing. Aim We aimed to evaluate the yield of the universal risk assessment in identifying MDRO carriers upon hospitalization. Methods We performed a cross-sectional study using routine healthcare data in a Dutch tertiary hospital between January 1st 2015 and August 1st 2019. MDRO risk assessment upon hospitalization included assessment of: known MDRO carriage, previous hospitalization in another Dutch hospital during an outbreak or a foreign hospital, living in an asylum centre, exposure to livestock farming and household membership of a methicillin-resistant Staphylococcus aureus carrier. Findings 144,051 admissions of 84,485 unique patients were included. In total, 4,480 (3.1%) admissions had a positive MDRO risk assessment. In 1,516 (34%) admissions microbiological screening was performed, of which 341 (23%) yielded MDRO. 81 patients were categorized as new MDRO carriers, as identified through MDRO risk assessment, reflecting 0.06% (95% CI: 0.04%–0.07%) of all admissions and 1.8% (95% CI: 1.4%–2.2%) of those with positive risk assessment. As a result, the number of ‘MDRO risk-assessments needed to perform’ and individual ‘MDRO-questions needed to ask‘ to detect one new MDRO carrier upon hospitalization were 1,778 and 10,420, respectively. Conclusions We conclude that the yield of the current strategy of MDRO risk assessment upon hospitalization is limited and that it needs thorough reconsideration.