# P-1763. Disease burden of carbapenem-resistant Enterobacterales (CRE) infections in Korea

## TL;DR

This study estimates the health and economic impact of carbapenem-resistant Enterobacterales infections in Korea, finding high mortality and significant costs.

## Contribution

The study provides the first comprehensive assessment of CRE infection burden in Korea using a predictive model and real-world data.

## Key findings

- CRE infections accounted for 22.4% of reported cases, with high mortality rates and significant medical costs.
- Klebsiella pneumoniae was the most common CRE pathogen, and carbapenemase-producing strains dominated.
- The estimated economic burden of CRE infections in 2022 was over $517 million in Korea.

## Abstract

Carbapenem-resistant Enterobacterales (CRE) pose a significant public health threat. While CRE isolation from clinical specimens is a mandatory national notifiable event in Korea, current surveillance systems do not differentiate between colonization and infection, hindering accurate estimation of the disease burden. This study aimed to assess the clinical and socio-economic burden of CRE infections in Korea.

A retrospective study was conducted across fifteen geographically diverse medical institutions. Medical records from all cases with CRE-positive clinical specimens in 2022 were reviewed and classified as “CRE-infected” or “colonized.” For the “CRE-infected” cohort, clinical data and medical costs were collected. A predictive logistic regression model was developed using sex, age, presence of bacteremia, and bacterial species to estimate the nationwide CRE infections. For cases of CRE bacteremia, matched control groups (no-infection, 3rd generation-cephalosporin-susceptible [3GC-S], and 3GC-resistant [3GC-R] infections) were used to assess the incremental burden of CRE.

Of 4,848 reported CRE cases, accounting for 15.9% of the 30,548 reported in Korea, 1,087 (22.4%) were classified as infections, including 586 bacteremic cases. Intra-abdominal infection (34.0%) and pneumonia (31.3%) were the most common infection sites. Klebsiella pneumoniae was the most frequent pathogen (77.0%) of CRE infections. Carbapenemase-producing Enterobacterales accounted for 74.2%, with KPC (84.4%) being the most common type. The 30-day and 90-day mortality rates were 29.3% and 40.8%, respectively. Nationwide, 7,117 CRE infections were estimated by the predictive logistic regression model, including 1,897 bacteremia. The total cost per CRE infection was estimated at $78,071. The economic burden of CRE infections in 2022 was estimated at $517,610,261, exceeding that of no-infection, 3GC-S, and 3GC-R infections by $108,355,500 to $401,087,500.

This study confirmed the profound clinical and socioeconomic burden of CRE infections in Korea. Considering the rapidly increasing number of reported CRE cases even after 2022, it is urgent to prepare corresponding measures against CRE infections.

Kyoung-Ho Song, MD, PhD, PhAST Corp.: Advisor/Consultant|PhAST Corp.: Grant/Research Support