South Korea's CRE Cases Reach Record 44,930 as Seniors Bear the Heaviest Burden

December tally passes the whole of 2024

South Korea recorded 44,930 cases of carbapenem resistant Enterobacterales (CRE) as of December 1, 2025, already exceeding the 42,347 infections reported during all of 2024. The increase is putting hospitals, nursing hospitals and institutions providing long term care under growing pressure, with older patients accounting for most reported infections.

The December tally was 2,583 cases above the previous year's total, an increase of about 6.1 percent with a month of the year still remaining. Health officials describe the rise as the fastest since nationwide monitoring began in 2018. As of December 16, the figure available for 2025 covered the period through December 1.

The Korea Disease Control and Prevention Agency (KDCA) has recorded an increase every year since CRE became subject to mandatory reporting in 2017. These bacteria resist carbapenems, a class of powerful antibiotics used as a last line of treatment when other medicines fail. Resistance leaves clinicians with fewer treatment choices and patients with greater risks.

People aged 60 and above account for 86.3 percent of reported infections. More than 31,000 cases involve patients aged 70 and above. The concentration among seniors places infection prevention in facilities caring for older people at the center of the response.

South Korea also has high antibiotic consumption. In 2023, use reached 31.8 defined daily doses per 1,000 people, compared with an OECD average of 18.3. KDCA is preparing its Third National Antimicrobial Resistance Management Plan for 2026 to 2030, with the aim of reducing unnecessary antibiotic use, protecting medicines that still work and strengthening infection prevention.

What makes CRE difficult to treat?

Enterobacterales are a large order of bacteria found in the human gut and the environment. They include E. coli, Klebsiella pneumoniae and Enterobacter species. In healthy people, these organisms can live in the body without causing illness, a condition called colonization.

Hospitalized patients and people with weakened immune systems face a different risk. These bacteria can cause serious infections in the bloodstream, lungs, urinary tract, wounds and surgical sites. Colonized patients can also carry bacteria that spread to others, making their identification important in healthcare settings.

Carbapenems are normally reserved for severe infections. When Enterobacterales become resistant to them, treatment can require combinations of older antibiotics or newer, expensive medicines. Clinicians may need specialist advice, several drugs and close monitoring for side effects.

The term superbugs is often used for organisms such as CRE because they withstand important antibiotics. The practical problem is straightforward: a medicine that would normally help control an infection may no longer work, leaving fewer ways to treat someone who is already seriously ill.

How bacteria move through care facilities

CRE transmission happens mainly in healthcare environments. Contact with an infected or colonized patient, contaminated equipment, staff hands or contaminated surfaces can pass the bacteria from one person to another.

Bed rails, ventilator tubes, catheters and even sink drains can harbor these organisms when cleaning is inconsistent. Crowded wards, frequent use of medical devices and high antibiotic exposure create conditions in which resistant bacteria can circulate.

Patients who remain in hospital for longer periods, receive multiple antibiotics or undergo invasive procedures face greater risk. A catheter or other device can provide a route into the body, while repeated contact with equipment and caregivers creates more opportunities for transmission.

Nursing hospitals, institutions providing long term care and other settings where people receive care together are vulnerable points in infection control. Meticulous hand hygiene, environmental cleaning and careful management of medical devices are therefore central to preventing spread.

A rise that began before the pandemic

KDCA's annual figures show that CRE was an established problem before the pandemic and has continued to grow. Mandatory reporting began in 2017, followed by nationwide monitoring in 2018. The reporting timeline shows the scale of the increase:

• 2017: 5,717 cases, the year CRE entered mandatory reporting.
• 2018: 11,954 cases.
• 2019: 15,369 cases.
• 2020: 18,113 cases.
• 2021: 23,311 cases.
• 2022: 30,548 cases.
• 2023: 38,405 cases.
• 2024: 42,347 cases.
• December 1, 2025: 44,930 cases recorded for the year so far.

The 2025 tally is about 3.8 times the 11,954 cases recorded in 2018. The continuing rise reflects a changing threat mix in a country with a rapidly aging population, high antibiotic consumption and increasingly complex hospital care.

Expanded diagnostic testing and stronger surveillance have likely helped identify cases that previously would have been missed. KDCA has also modernized its data systems, improving the speed and completeness of reporting. Integrated infectious disease information platforms and regular hospital reports make infections more visible.

Better detection is part of the explanation, alongside growing transmission pressure. The age profile of patients, the concentration of cases in nursing hospitals and facilities providing long term care, and the sustained annual increase point to a problem that extends beyond improvements in reporting.

Disruptions to routine care and changes in antibiotic prescribing after the pandemic have also played a role. Respiratory virus waves, seasonal increases in whooping cough and influenza, and crowded hospitals add pressure to infection control programs that require sufficient staff, training and time.

Why seniors carry most of the burden

Adults aged 60 and above account for more than eight in ten reported CRE infections. Patients aged 70 and above alone account for more than 31,000 cases in the 2025 tally, making the protection of older people a central concern.

Many older patients have chronic illnesses or weakened immune systems. Some need catheters, feeding tubes or regular wound care, increasing their exposure to procedures and devices associated with infection risk. They are also more likely to need hospitalization or live in a care facility.

Facilities caring for seniors often work with limited staff and tight budgets. Maintaining intensive infection prevention every hour of every day requires people to clean equipment, follow precautions, monitor patients and communicate risks during transfers.

South Korea's rapidly growing senior population increases the demand for this care. Preventing transmission depends on consistent daily practices across hospitals and care institutions, particularly where patients move between facilities or require prolonged treatment.

The human cost behind the case count

CRE infections are associated with longer hospital stays, higher costs and an increased risk of death. Patients may need intensive care, complicated treatment and prolonged rehabilitation, creating a heavy burden for families and healthcare services.

South Korea recorded 838 fatalities associated with CRE infections in 2024. In official reporting, CRE had the highest number of deaths among the major notifiable infections tracked outside tuberculosis. Notifiable infections are diseases that healthcare providers must report to health authorities.

International research also shows that bloodstream infections caused by carbapenem resistant Klebsiella pneumoniae can have much higher death rates during hospitalization than infections caused by strains that remain susceptible to antibiotics. A bloodstream infection is especially serious because bacteria have entered the blood and can affect the body widely.

Treatment often involves infectious disease specialists, multiple antibiotics or newer medicines, and careful checks for drug side effects. These demands make care expensive and consume substantial hospital resources, especially in intensive care units and among patients needing lengthy recovery and rehabilitation.

Antibiotic consumption increases the pressure

South Korea's antibiotic use in 2023 was the second highest among OECD countries with available data. Consumption of 31.8 defined daily doses per 1,000 people was about 74 percent above the OECD average of 18.3.

A defined daily dose is a standardized measure used to compare medicine consumption. It helps show how much antibiotic use differs between countries without simply counting prescriptions, which can involve different drugs, doses and treatment lengths.

Easy access to healthcare and longstanding prescribing habits contribute to frequent antibiotic use, including for illnesses that do not need these medicines. Viral colds are one example. Antibiotics act against bacteria, not the viruses that cause colds or influenza.

Unnecessary prescriptions create selective pressure. Antibiotics kill bacteria that are vulnerable to them, while resistant bacteria can survive and multiply. Repeated exposure helps resistance build across many types of bacteria, including CRE.

Antimicrobial stewardship programs aim to improve prescribing. Hospital teams review prescriptions daily, match treatment to laboratory results and check the dose and duration. Pharmacists, infectious disease physicians and microbiologists work together to guide those decisions.

A national pilot to expand stewardship teams began in 2024. Early work focuses on clear guidelines, training and teams that bring together different specialties, so appropriate antibiotic use becomes routine in both large hospitals and smaller facilities.

Resistance also reaches beyond hospitals

South Korea's response includes a One Health approach, which recognizes connections between human health, animal health and the environment. Antibiotic use and resistant bacteria outside hospitals also matter to the national effort.

Veterinary antibiotic use, prescription requirements for livestock, food safety in agriculture and wastewater management all influence the spread of resistant organisms. Korea has introduced controls on veterinary prescriptions and strengthened food safety rules, while continued attention is needed to limit unnecessary antimicrobial use across sectors.

Coordination between ministries responsible for people, animals and environmental protection is part of the strategy under preparation. The aim is to address resistance across those connected settings while preserving effective treatments.

What the 2026 to 2030 plan will target

KDCA is finalizing the Third National Antimicrobial Resistance Management Plan for 2026 to 2030. Its stated aims are 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 stewardship in hospitals and clinics, improving rapid diagnostics and laboratory capacity, and reinforcing standard infection control in nursing hospitals and institutions providing long term care. Public education would explain when antibiotics help and when they do not.

The strategy also points to cooperation across ministries and support for research and development of new antimicrobials and diagnostic tools. As of December 16, a finalization date had not been given, and the priorities described remained under discussion.

Rapid laboratory results can help clinicians identify resistant bacteria and choose treatment sooner. Stronger stewardship capacity can support those decisions, while infection prevention reduces opportunities for bacteria to reach another patient.

Practical measures for hospitals and care teams

Hospitals and care institutions can reduce CRE transmission through established measures applied consistently. Many are straightforward, but they require leadership support, enough trained staff and regular checks that practices are being followed.

• Maintain rigorous hand hygiene among staff, patients and visitors, with frequent audits and feedback.
• Use contact precautions for patients with known or suspected CRE, including gloves, gowns and dedicated medical equipment.
• Screen patients at high risk on admission to identify carriers and guide their placement.
• Group affected patients together and assign staff to their care when necessary to contain spread within a unit.
• Clean and disinfect rooms, devices and frequently touched surfaces thoroughly, with particular attention to sinks and drains.
• Reassess antibiotics after 48 to 72 hours to check whether they are needed, narrow treatment where possible and stop unnecessary medicines.
• Arrange pharmacist and infectious disease team reviews of complex cases and expensive therapies.
• Communicate a patient's CRE status clearly during transfers between facilities.

KDCA Commissioner Jee Young mee stressed the role of frontline reporting by hospitals and clinics in detecting outbreaks early and limiting transmission:

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.

Awareness among staff and families, access to rapid laboratory results and investment in stewardship teams can support immediate improvements while national programs expand. Facility leaders need to set clear expectations, measure performance and support the teams responsible for daily prevention work.

Other infectious disease surges add strain

South Korea is confronting the CRE increase while healthcare services manage other infectious disease pressures. After the pandemic's peak, the country recorded sharp increases in infectious diseases other than COVID-19 during 2024, including a large whooping cough wave and increases in scarlet fever and chickenpox.

Seasonal influenza has strained clinics during intense weeks. Some facilities have also reported pressures on medicine supplies during peak periods. More patients with respiratory infections can mean more antibiotic prescribing and more hospital admissions among vulnerable seniors.

Those pressures can increase the risks associated with antimicrobial resistance unless prescribing controls and infection prevention keep pace. Crowded services also need enough time, training and staff to maintain cleaning, screening and other precautions.

The World Health Organization classifies antimicrobial resistance as a top public health threat. International estimates link millions of deaths each year to infections in which resistance played a role. South Korea's combination of rapid aging, high antibiotic use and well developed healthcare access shows how resistance can become a daily challenge for care teams.

Decisions on prescribing, surveillance and protection of facilities serving vulnerable patients will affect how the country manages that challenge over the coming years. The immediate priorities are preventing transmission and preserving the medicines clinicians still have available.

What patients and families can do

Patients and relatives cannot control a hospital's staffing or cleaning systems, but they can take practical steps to reduce risk and help care teams make informed decisions.

• Ask a clinician whether an antibiotic is needed. Antibiotics do not treat viruses such as those that cause colds or influenza.
• Take prescribed antibiotics exactly as directed and do not save leftover medicine.
• Clean hands when visiting hospitals or care facilities and follow instructions on protective clothing.
• Keep vaccinations up to date, including influenza and COVID-19 vaccines for seniors and people with chronic conditions, to reduce hospitalizations that increase exposure risk.
• Politely remind care staff about hand hygiene before procedures or medical device care.
• Tell clinicians about previous CRE infections or colonization when checking into a clinic or hospital, especially during transfers between facilities.

Sharing a history of CRE helps the receiving facility plan precautions and placement. Following instructions on medicines, hand hygiene and protective clothing supports the same prevention work carried out by hospital and care staff.

Key Points

• South Korea reported 44,930 CRE cases through December 1, 2025, exceeding the 42,347 recorded throughout 2024.
• Cases have risen every year since mandatory reporting began in 2017.
• Adults aged 60 and above account for 86.3 percent of reported infections; more than 31,000 cases involve people aged 70 and above.
• CRE resist carbapenems, leaving fewer treatment options for serious infections.
• Nursing hospitals and facilities providing long term care are vulnerable to transmission through contact and contaminated equipment.
• CRE infections were associated with 838 fatalities in South Korea in 2024.
• Antibiotic consumption reached 31.8 defined daily doses per 1,000 people in 2023, compared with the OECD average of 18.3.
• KDCA is preparing its Third National Antimicrobial Resistance Management Plan for 2026 to 2030.
• Hand hygiene, screening, contact precautions, careful cleaning, transfer communication and better prescribing are central to reducing spread.