South Korea is confronting a sharp rise in infections from one of the world’s most dangerous types of bacteria, carbapenem-resistant Enterobacterales, or CRE. Over seven years, reported cases have jumped from 5,717 in 2017 to 44,930 by early December 2025, a 685% increase. The surge, especially rapid in 2024, is forcing hospitals and public health officials to rethink how they manage infections and use antibiotics.
What Makes CRE So Dangerous
CRE refers to a group of common gut bacteria, such as Klebsiella pneumoniae, that have evolved to resist carbapenems, a class of powerful antibiotics used when other drugs fail. The World Health Organization classifies these organisms as critical-priority threats. Because CRE can survive standard treatments, doctors are often forced to turn to older, more toxic antibiotics, which carry higher risks of side effects. These bacteria spread easily in hospitals and long-term care facilities, where vulnerable patients are already weakened by illness.
Antibiotic Use Fuels the Surge
South Korea’s high rate of antibiotic use is a major driver of this crisis. In 2023, the country ranked second among OECD nations, with 31.8 daily antibiotic doses per 1,000 people, nearly double the OECD average of 18.9. This increase follows a period of relaxed prescribing after the pandemic, including frequent use of antibiotics for colds and minor infections where they are not needed. Overuse accelerates the development of resistance, allowing CRE and similar pathogens to thrive.
Elderly Patients Bear the Brunt
The heaviest burden falls on older adults. Patients aged 60 and above account for 86.3% of CRE infections, with more than 31,000 of the 44,930 cases occurring in those over 70. Nursing homes and long-term care facilities have become hotspots, where weakened immune systems, multiple chronic conditions, and close living quarters make residents especially susceptible. Studies show that patients over 70 are far more likely to test positive for CRE than younger individuals.
How CRE Spreads in Facilities
Transmission occurs mainly through the hands of healthcare workers and contaminated equipment. CRE can survive for long periods on bed rails, in sink drains, and on medical devices. Strict infection control—consistent hand hygiene, protective gear, and thorough cleaning of high-touch surfaces—is essential to stop spread. Many facilities, especially smaller nursing homes, lack the staff and resources to maintain these standards, allowing CRE to circulate silently until outbreaks emerge.
High Mortality and Rising Costs
CRE bloodstream infections are deadly. Patients with carbapenem-resistant Klebsiella pneumoniae face in-hospital death rates of about 42%, compared to 21% for non-resistant strains. ICU patients are at even greater risk. Treatment is also extremely costly, with individual cases running from $29,000 to $86,000. These expenses strain a healthcare system already under pressure from an aging population, as long hospital stays and intensive care consume staff time and resources.
Treatment Exists, but Resistance Looms
Despite alarming headlines, effective treatments are available. Antibiotics such as ceftazidime-avibactam, meropenem-vaborbactam, imipenem-relebactam, and cefiderocol were specifically developed to combat CRE. Studies show ceftazidime-avibactam leads to lower 30-day death rates and higher cure rates than older regimens. However, these drugs are not risk-free; they can cause serious side effects, and their effectiveness depends on careful use. Overuse of these newer antibiotics is already leading to strains that resist them, narrowing the window for effective treatment.
National and Global Implications
South Korea’s experience reflects a global trend. Carbapenem resistance has been rising across Europe, Asia, and North America since the 1990s. Worldwide, antimicrobial resistance is linked to about 4.95 million deaths each year, a toll comparable to HIV and malaria. Without stronger action, projections suggest that number could reach 10 million annually by 2050. South Korea’s decisions on antibiotic use, infection control, and stewardship now have implications far beyond its borders.
The Path Forward
The Korea Disease Control and Prevention Agency is finalizing its Third National Antimicrobial Resistance Plan for 2026–2030, aiming to reduce antibiotic use and strengthen infection control. Pilot Antimicrobial Stewardship Programs have shown early success, with participating hospitals far more likely to monitor prescriptions and choose better drugs based on lab results. But major barriers remain: many large hospitals lack trained antibiotic specialists, and small facilities often cannot afford stewardship programs. Without sustained investment in training, staffing, and regulations, progress will remain uneven, leaving the most vulnerable populations at continued risk.
Sources
Korea Herald, December 5, 2025
Korea Disease Control and Prevention Agency