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Study Identifies Top Infection-Control Priority
South Korean health authorities have identified carbapenem-resistant Enterobacterales, or CRE, as the country’s highest-priority drug-resistant bacteria for hospital infection control.
The Korea Disease Control and Prevention Agency and a research team led by infectious disease specialist Song Kyoung-ho of Seoul National University Bundang Hospital announced the findings on Oct. 28. The researchers ranked several major multidrug-resistant organisms by examining how frequently patients carried or developed infections from them, as well as disease severity, hospital stays, medical costs, duration of carriage, recent trends and available treatments.
CRE placed first overall, followed by vancomycin-resistant enterococci, known as VRE, and multidrug-resistant Acinetobacter baumannii, or MRAB. Methicillin-resistant Staphylococcus aureus, widely known as MRSA, and multidrug-resistant Pseudomonas aeruginosa, or MRPA, received lower priority scores.
Carbapenems are powerful antibiotics often reserved for severe infections. Bacteria resistant to them can leave doctors with fewer treatment options. Of particular concern are CRE strains that produce carbapenemase enzymes, known as CP-CRE, because they can transfer resistance genes to other bacteria and accelerate the spread of resistance inside hospitals.
Hospitals Show Uneven Staffing and Isolation Capacity
The study found substantial differences in infection-control resources among the 21 participating hospitals. All had infectious disease specialists, but only one hospital, or 5%, employed a physician dedicated exclusively to infection control. Just one also had personnel assigned specifically to environmental management of multidrug-resistant organisms.
Isolation practices varied by pathogen. Every hospital isolated patients with CP-CRE in both general wards and intensive care units, while only eight isolated patients with MRSA. Even among hospitals practicing isolation, only 10% to 30% used separately designated isolation areas.
The researchers said the findings support greater investment in prevention, including early screening, patient isolation, environmental controls and additional infection-control staff. Such measures, they concluded, are more cost-effective than managing the consequences after infections occur.
Thousands of Patients Carried Resistant Bacteria
Among 49,651 hospitalized patients included in the surveys, 3,226 carried a multidrug-resistant organism without necessarily showing symptoms, a point prevalence of 6.5%. Another 709 had an active infection, representing 1.43%.
CRE had the highest carriage prevalence at 1.79%, followed by VRE at 1.73% and MRSA at 1.59%. The order changed for active infections involving symptoms and tissue invasion: MRSA ranked highest at 0.53%, followed by CRE at 0.30%, VRE at 0.23%, MRAB at 0.22% and MRPA at 0.15%.
Thirty-day mortality among infected patients was 18.6% for VRE, 16.9% for CRE, 12.4% for MRSA, 10.9% for MRAB and 6.5% for MRPA. Researchers cautioned that these figures represent deaths from all causes, not deaths attributed solely to the bacterial infection. They also reflect patients’ underlying illnesses, weakened immune systems and infections involving other pathogens.
Median hospital stays were longest for patients with MRPA and MRAB, at 66 days, followed by CRE at 60 days, VRE at 58 days and MRSA at 44 days. Median medical costs per infection ranged from 29 million won for MRSA to 59 million won for VRE. Costs reached 55 million won for MRAB and 46 million won for CRE.
Within six months, 60.3% of MRAB carriers were cleared from infection-control monitoring, compared with 58.6% for MRSA, 53.8% for VRE, 51.4% for CRE and 47.5% for MRPA. An analysis of 420 bacterial isolates also found virulence genes in 56% of certain Klebsiella pneumoniae strains classified as CRE.
Authorities Plan Expanded CRE Response
The multicenter cross-sectional study surveyed inpatients at 21 hospitals using the same standards in April, July and October 2024 and January 2025. It was conducted as a KDCA-commissioned project, with the research period listed as running from Sept. 25, 2024, through Dec. 24, 2025.
The agency described it as South Korea’s first multicenter study to assess, using actual inpatient data, the prevalence, severity, hospital stays, costs, bacterial characteristics and infection-control conditions associated with major multidrug-resistant organisms.
Researchers acknowledged several limitations. The study focused partly on large hospitals and included relatively few cases for some bacteria. It also did not separately determine how much each infection contributed to a patient’s death, which may have caused VRE to rank higher than its actual burden would warrant.
The KDCA said it will use the findings to continue developing a national CRE reduction strategy and strengthen regional hospital networks for managing health care-associated infections. Planned measures include expanded early screening, more standardized isolation and environmental controls, increased staffing and additional on-site support.
Song said the data demonstrated the clinical and economic burden of multidrug-resistant bacteria, including high carriage, infection and mortality rates and relatively low rates of release from monitoring. He called for regular large-scale prevalence surveys, systems that allow hospitals to share clinical information about carriers, and public funding for active surveillance and isolation.
KDCA Commissioner Lim Seung-kwan said multidrug-resistant bacteria are a global public health challenge directly tied to patient safety. He said the agency plans to expand its CRE strategy and improve regional response systems so patients can receive hospital care more safely.
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