Cases of bacteria that resist antibiotics have risen fivefold in South Korea over seven years, with reports at long-term care hospitals surging 23-fold over the same period.
The number of patients with carbapenem-resistant Enterobacterales (CRE) climbed to 3,292 in 2025 from 655 in 2018, according to data submitted by the Korea Disease Control and Prevention Agency to the office of Rep. Han Ji-a of the People Power Party, a member of the National Assembly's Health and Welfare Committee, on the 19th.
CRE is a so-called superbug resistant to nearly all antibiotics, leaving very few treatment options once a patient is infected. Total CRE reports also more than quadrupled over the period, to 49,053 from 11,954.
The burden falls heavily on older patients. Of all CRE reports in 2025, 34,121 cases, or 69.6%, involved people aged 70 and over. Reports at long-term care hospitals soared to 12,045 in 2025 from 524 in 2018, a 23-fold increase. By region, Seoul had the highest report rate at 134.75 per 100,000 people, followed by Incheon at 128.01, Busan at 103.59 and Gyeonggi Province at 98.19.
Behind the surge is rising antibiotic use. Domestic antibiotic consumption, measured in defined daily doses per 1,000 people (DID), fell to 19.5 in 2021 from 29.8 in 2018 before rebounding to 25.7 in 2022, 31.8 in 2023 and 33.6 in 2024 — a 72.3% jump in three years.
The main reason CRE spreads so quickly is transmission without symptoms. Most CRE infections occur in medical facilities, spreading through the hands of medical staff or caregivers and through the hospital environment. Carriers who show no symptoms can pass the bacteria to other patients through hand contact alone, allowing it to spread quietly inside hospitals.
Transmission is even faster in settings such as long-term care hospitals, where elderly patients with weakened immune systems are concentrated. Resistance genes can also move between bacteria via plasmids, a trait cited as another factor fueling outbreaks within medical institutions.
The government has set a target of cutting antibiotic use to 28.6 DID by 2030, but that would require a 14.9% reduction from the 2024 level, making the goal difficult to reach.
The government has run a pilot program on antimicrobial stewardship (ASP) since 2024, but it covers only 170 general and tertiary hospitals with more than 300 beds. A pilot program for hospital-level facilities, including long-term care hospitals, is not scheduled to begin in earnest until 2030.
Han said the policy response is far too slow compared with the pace of spread on the ground, adding that a system to identify high-risk areas at the regional level and respond pre-emptively must be built immediately.
