South Korea Sees Record Surge in Carbapenem Resistant Infections, Seniors Hit Hard

A growing threat reshapes care in hospitals and senior facilities

Infections caused by carbapenem resistant Enterobacterales are climbing to record levels in South Korea. National surveillance counted 44,930 cases as of Dec 1, 2025. The total already exceeds the 42,347 infections tallied during all of 2024. Health officials describe the fastest rise since nationwide monitoring began in 2018. These organisms, often called superbugs, resist carbapenems, a last line class of antibiotics used when other treatments fail. When they spread in hospitals and care facilities, clinicians face fewer options, and patients face higher risks.

The Korea Disease Control and Prevention Agency (KDCA) has tracked a steady increase each year since CRE entered mandatory reporting in 2017. Annual reports rose from 5,717 in 2017 to 11,954 in 2018, 15,369 in 2019, 18,113 in 2020, 23,311 in 2021, 30,548 in 2022 and 38,405 in 2023, with 42,347 recorded in 2024. The 2025 total has now crossed that trend line. The surge reflects a changing threat mix in a country with a rapidly aging population and high antibiotic use.

The burden falls heavily on older adults. People aged 60 and above account for 86.3 percent of reported infections, and more than 31,000 cases are in patients aged 70 and above. Nursing hospitals, long term care institutions and other congregate care sites are vulnerable points in infection control. CRE spread through contact with infected or colonized patients or contaminated equipment, which makes meticulous hand hygiene, environmental cleaning and careful device management vital. Prolonged hospital stays, higher costs and increased mortality often follow. South Korea also ranks near the top in antibiotic consumption among OECD members. In 2023, use reached 31.8 defined daily doses per 1,000 people, far above the OECD average of 18.3. KDCA is preparing a national plan for 2026 to 2030 to reduce unnecessary antibiotic use, preserve effective treatments and strengthen infection prevention.

What is CRE and why it matters

Enterobacterales are a large order of bacteria that live in the human gut and the environment. They include E. coli, Klebsiella pneumoniae and Enterobacter species. In healthy people, these bacteria can be harmless colonizers. In hospitalized or immunocompromised patients, they can cause serious infections of the bloodstream, lungs, urinary tract, wounds and surgical sites. Carbapenems are powerful antibiotics reserved for severe infections. When Enterobacterales develop resistance to carbapenems, infections can be very difficult to treat and require combinations of older drugs or newer, costly agents.

How CRE spread in care settings

Transmission happens mainly in healthcare environments. Contact with an infected or colonized patient, the hands of staff or contaminated surfaces and devices can pass CRE from person to person. Bacteria can persist on bed rails, ventilator tubes, catheters and even sink drains if cleaning is inconsistent. Crowded wards, frequent device use and high antibiotic exposure create ideal conditions for resistant organisms to circulate. Patients who stay longer, receive multiple antibiotics or undergo invasive procedures face greater risk.

Seven years of steady growth, and why numbers keep rising

South Korea’s surveillance indicates that CRE was a recognized problem before the pandemic and has grown each year since mandatory reporting began. Expanded diagnostics and stronger surveillance have likely increased detection. KDCA has also modernized data systems, which improves reporting speed and completeness. Even with better detection, experts point to clear drivers of a true increase in cases: high antibiotic use, greater complexity of hospital care, and the rapid growth of the senior population who are more likely to require hospitalization or reside in care facilities.

Better detection versus real increases

Improved monitoring helps find more cases that might have been missed in the past. Korea’s integrated infectious disease information platforms and regular hospital reporting raise visibility. Yet the age profile of cases, the concentration in nursing hospitals and long term care facilities, and sustained year to year growth point to genuine transmission pressure. Post pandemic disruptions in routine care and antibiotic prescribing patterns have also played a role. Respiratory virus waves, seasonal surges of infections such as whooping cough and influenza, and increased hospital crowding add strain to infection control programs that need time, training and staff to maintain rigorous standards.

Seniors bear the brunt of the surge

Older adults are at the center of this crisis. Patients aged 60 and above account for more than eight in ten reported cases. Those 70 and older alone make up more than 31,000 infections this year to date. Many of these patients live with chronic illnesses and weakened immune systems. Many require catheters, feeding tubes or wound care that increase infection risk. Facilities that care for seniors often operate with limited staff and tight budgets, which makes it hard to sustain intensive infection prevention measures every hour of every day.

Clinical outcomes and costs

CRE infections are linked to longer hospital stays and higher risk of severe outcomes. International research shows that bloodstream infections caused by carbapenem resistant Klebsiella pneumoniae can have in hospital death rates that are much higher than infections caused by susceptible strains. In South Korea, official reporting of notifiable diseases shows the human toll as well. In 2024, CRE infections were associated with the highest number of deaths among major notifiable infections tracked outside of tuberculosis, with 838 fatalities recorded. Treatment often requires specialist input, multiple or newer antibiotics and close monitoring for drug side effects. Care is expensive and resource intensive, especially in intensive care units and for patients who require prolonged rehabilitation.

Antibiotic use in Korea remains high, and stewardship is now essential

Antibiotic consumption in South Korea is among the highest in the OECD. In 2023, usage stood at 31.8 defined daily doses per 1,000 people, compared with an OECD average of 18.3. Easy access to care and long standing prescribing habits contribute to frequent antibiotic use for conditions that do not need antibiotics, such as viral colds. Each unnecessary prescription creates selective pressure that helps resistant bacteria thrive. Over time, resistance accumulates across many organisms, including CRE.

Antimicrobial stewardship programs are designed to improve how antibiotics are prescribed. Hospitals with strong stewardship review prescriptions daily, match drug choices to laboratory results, check doses and duration, and work with pharmacists, infectious disease physicians and microbiologists to guide care. A national pilot to expand stewardship teams began in 2024. Early efforts focus on clear guidelines, training, and building multidisciplinary teams so that appropriate use becomes the norm in large hospitals and smaller facilities alike.

One Health pressures outside hospitals

Resistance does not stop at the hospital door. A One Health approach recognizes links across human health, animal health and the environment. Veterinary antibiotic use, prescription requirements for livestock, food safety in agriculture and wastewater management all influence the spread of resistant bacteria. Korea has introduced controls on veterinary prescriptions and strengthened food safety rules, but continued attention is needed to limit unnecessary antimicrobial use across sectors.

What South Korea is preparing now

KDCA is finalizing the Third National Antimicrobial Resistance Management Plan for 2026 to 2030. The plan aims to reduce inappropriate antibiotic use, preserve the effectiveness of existing treatments and strengthen infection prevention in healthcare and community settings. Priorities under discussion include expanding antimicrobial stewardship in hospitals and clinics, improving rapid diagnostics and laboratory capacity, reinforcing standard infection control in nursing hospitals and long term care, and promoting public education about when antibiotics help and when they do not. The strategy also points to coordination across ministries responsible for human health, animal health and environmental protection, and to support for research and development of new antimicrobials and diagnostics.

What hospitals and care facilities can do now

Evidence based measures can reduce CRE spread if they are applied consistently. Many steps are straightforward but require leadership support and enough trained staff to stay on track.

• Rigorous hand hygiene for all staff, patients and visitors, with frequent audits and feedback
• Contact precautions for patients with known or suspected CRE, including gloves, gowns and dedicated medical equipment
• Active screening of high risk patients on admission to identify carriers and guide placement
• Cohorting patients and staff when needed to contain spread in a unit
• Thorough cleaning and disinfection of rooms, devices and high touch surfaces, with special attention to drains and sinks
• Antibiotic time outs at 48 to 72 hours to reassess need, narrow therapy and stop unnecessary drugs
• Pharmacist and infectious disease team review of complex cases and high cost therapies
• Clear communication of CRE status during patient transfers between facilities

KDCA leaders have emphasized the importance of early reporting and coordinated action. KDCA Commissioner Jee Young mee stressed that frontline reporting from hospitals and clinics is a critical defense against outbreaks.

Reporting infectious disease is the first line of defense to minimize the damage from the spread of diseases, by detecting them at an early stage and stop its transmission to the community.

Raising awareness among staff and families, improving access to rapid laboratory results, and investing in stewardship capacity can help facilities make immediate progress while national programs scale up. Real gains come when leadership sets clear expectations, measures performance and supports the teams doing the daily work.

The broader public health backdrop

CRE is rising at a time when healthcare systems are managing other surges. After the peak of the pandemic, Korea recorded sharp increases in non Covid infectious diseases in 2024, including a large wave of whooping cough and a jump in scarlet fever and chickenpox. Seasonal influenza has also strained clinics during intense weeks, and some facilities have reported medicine supply pressures during peak periods. More patients with respiratory infections mean more antibiotics are prescribed and more hospitalizations for vulnerable seniors, a combination that can magnify antimicrobial resistance risks unless stewardship and infection control keep pace.

Global agencies continue to warn about antimicrobial resistance. The World Health Organization classifies it as a top public health threat. International estimates link millions of deaths each year to infections in which resistance played a role. Korea’s experience, with high antibiotic use, rapid aging and well developed healthcare access, shows how quickly resistance can become a front line challenge. Decisions made now on prescribing, surveillance, and the protection of high risk facilities will shape outcomes for years to come.

What patients and families can do

Individuals cannot control hospital systems, yet there are practical steps that reduce risk for you and the people you care for.

• Ask your clinician if an antibiotic is truly needed. Antibiotics do not treat viruses like colds or the flu
• If an antibiotic is prescribed, take it exactly as directed and do not save leftovers
• Practice hand hygiene when visiting hospitals or care facilities, and follow staff instructions for protective clothing
• Ensure vaccinations are up to date, including influenza and Covid vaccines for seniors and those with chronic conditions, to reduce hospitalizations that increase exposure risk
• Remind care staff politely about hand hygiene before procedures or device care
• Share information about past infections or colonization with CRE during clinic or hospital check in, especially when transferring between facilities

Key Points

• 44,930 carbapenem resistant Enterobacterales infections were reported in South Korea as of Dec 1, 2025, already surpassing the 2024 total of 42,347
• Cases have increased every year since mandatory surveillance began in 2017, reflecting sustained growth in resistant infections
• Seniors are most affected, with 86.3 percent of cases in people aged 60 and above and more than 31,000 in those 70 and older
• Nursing hospitals and long term care facilities are critical hotspots for spread through contact and contaminated equipment
• South Korea’s antibiotic use was 31.8 defined daily doses per 1,000 people in 2023, the second highest among OECD countries with available data
• KDCA will finalize the Third National Antimicrobial Resistance Management Plan for 2026 to 2030, prioritizing stewardship, prevention and surveillance
• CRE infections were linked with 838 deaths among major notifiable diseases in 2024, underscoring the human cost
• Hospitals can curb spread with strict hand hygiene, contact precautions, active screening, careful cleaning and strong antimicrobial stewardship