Ewha Med J.  2024 Jul;47(3):e34. 10.12771/emj.2024.e34.

Status of and comprehensive preventive strategies for multidrug-resistant organisms in Korea: a focus on carbapenem-resistant Enterobacterales

• Park DH
• Choe PG

• KMID: 2558571
• DOI: http://doi.org/10.12771/emj.2024.e34

Abstract

The rise of multidrug-resistant organisms represents a serious global public health concern. In Korea, the increasing prevalence of carbapenem-resistant Enterobacterales (CRE) is particularly concerning due to the difficulties associated with treatment. Data from the Korea Global Antimicrobial Resistance Surveillance System indicate a yearly increase in CRE cases, with carbapenemase-producing Enterobacterales being the predominant type. The capacity of CRE to resist multiple broad-spectrum antibiotics leads to higher medical costs and mortality rates, underscoring the need for urgent action. Effective prevention is crucial to curbing CRE outbreaks and transmission. Antimicrobial stewardship programs (ASPs) play a key role and require commitment from healthcare professionals to minimize unnecessary antibiotic use, as well as from policymakers to ensure adherence to ASP guidelines. Given the complexity of CRE transmission, ASP efforts must be integrated with infection control strategies for maximum effectiveness. These strategies include adherence to standard and contact precautions, environmental disinfection, preemptive isolation, and comprehensive education and training for healthcare personnel. Additionally, surveillance testing for patients at high risk for CRE and the use of real-time diagnostic kits can facilitate early detection and reduce further transmission. Strategies for the prevention of CRE infection should be tailored to specific healthcare settings. Ongoing research is essential to update and refine infection control guidelines and effectively prevent CRE outbreaks.

Keyword

Antimicrobial stewardship; Bacterial drug resistance; Carbapenemase; Infection control; Republic of Korea

Figure

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  Fig. 1. Rates of antimicrobial resistance for multidrug-resistant pathogens from 2016 to 2020, based on data from the Korea Global Antimicrobial Resistance Surveillance System (Kor-GLASS). MRSA, methicillin-resistant Staphylococcus aureus; VREfm, vancomycin-resistant Enterococcus faecium; CRKP, carbapenem-resistant Klebsiella pneumoniae; CRPA, carbapenem-resistant Pseudomonas aeruginosa; CRAB, carbapenem-resistant Acinetobacter baumannii.

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  Fig. 2. Annual numbers of CRE infections from 2018 to 2022 based on a mandatory surveillance system. CRE, carbapenem-resistant Enterobacterales.

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  Fig. 3. Annual distributions of carbapenemase-producing Enterobacterales from 2018 to 2022. KPC, Klebsiella pneumoniae carbapenemase; NDM, New Delhi metallo-beta-lactamase; VIM, Verona integron-encoded metallo-beta-lactamase; IMP, imipenemase; OXA, oxacillinase-48; GES, Guiana extended-spectrum beta-lactamase.

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  Fig. 4. Conceptual diagram of infection control strategies to prevent the spread of multidrug-resistant organisms.

Reference

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