Abstract illustration of antibiotic-resistant bacteria in a hospital setting.

The Silent Spread: Understanding Antibiotic Resistance in Korean ICUs

Samir D’Costa in Health & Wellness December 2025 • 4 min read.

"A Deep Dive into Fecal Transmission of ESBL-E and CRE"

Antibiotic resistance is a growing global health threat, turning common infections into potentially life-threatening conditions. Bacteria, constantly evolving, develop mechanisms to evade the effects of antibiotics, rendering these drugs less effective or entirely useless. This phenomenon is especially concerning in hospital environments, particularly in intensive care units (ICUs), where vulnerable patients are at high risk of acquiring infections.

Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) and carbapenem-resistant Enterobacteriaceae (CRE) are two significant types of antibiotic-resistant bacteria. ESBL-E are resistant to many common antibiotics, while CRE are resistant to carbapenems, often considered last-resort antibiotics. The spread of these organisms poses a serious challenge to healthcare systems worldwide.

A recent study conducted in Korea investigated the prevalence and transmission rates of ESBL-E and CRE in patients admitted to ICUs. The findings shed light on the dynamics of antibiotic resistance in this specific setting and offer valuable insights for infection control strategies. This article breaks down the key findings of the study, explaining their implications for healthcare professionals and the general public.

What Does Fecal Transmission Tell Us About Antibiotic Resistance?

Abstract illustration of antibiotic-resistant bacteria in a hospital setting.

The Korean study focused on fecal transmission because the gastrointestinal tract can act as a reservoir for antibiotic-resistant bacteria. Patients can carry these bacteria without showing any symptoms, shedding them through feces, which can then contaminate the environment and potentially spread to other individuals.

Researchers collected rectal swab samples from patients upon admission to ICUs in three teaching hospitals in Korea, and then followed up with samples taken at weekly intervals. The goal was to determine:

The prevalence of ESBL-E and CRE carriage among patients entering the ICU.
The rate at which patients who were initially free of these bacteria acquired them during their ICU stay (acquisition rate).
The genetic characteristics of the isolated bacteria to understand their relatedness.

Out of 347 ICU admissions, 98 patients (28.2%) were found to be carrying ESBL-E upon admission. This indicates a high level of pre-existing colonization within the patient population entering the ICUs. Follow-up cultures on initially ESBL-E-free patients showed an acquisition rate of 12.1% (11 out of 91 patients). In contrast, CRE carriage was much lower, with a prevalence of only 0.3% (1 out of 347 patients) and an acquisition rate of 2.9% (4 out of 140 patients).

Navigating the Future of Infection Control

The Korean study underscores the importance of continuous monitoring of antibiotic resistance patterns, adapting infection control strategies, and responsible antibiotic use. While the study focused on a specific region, its findings resonate globally. By understanding the dynamics of antibiotic resistance, healthcare professionals and policymakers can work together to protect vulnerable patients and safeguard the effectiveness of these essential medications.

About this Article -

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Everything You Need To Know

What are ESBL-E and CRE, and why are they concerning in the context of antibiotic resistance?

ESBL-E, or extended-spectrum beta-lactamase-producing Enterobacteriaceae, are bacteria that have developed resistance to many common antibiotics. CRE, or carbapenem-resistant Enterobacteriaceae, are even more concerning because they are resistant to carbapenems, which are often considered the last line of defense against bacterial infections. The rise of both ESBL-E and CRE poses a significant threat because they can turn treatable infections into life-threatening conditions, particularly in vulnerable populations such as those in intensive care units (ICUs). The inability to effectively treat infections due to antibiotic resistance complicates medical care and increases the risk of mortality.

How does fecal transmission contribute to the spread of antibiotic-resistant bacteria like ESBL-E and CRE?

Fecal transmission plays a crucial role in the spread of ESBL-E and CRE because the gastrointestinal tract acts as a reservoir for these bacteria. Patients can carry these antibiotic-resistant bacteria without showing symptoms, shedding them through their feces. This contaminated fecal matter can then spread to the environment and potentially infect other individuals through various routes, including direct contact or contaminated surfaces. The study in Korea highlighted that understanding the fecal transmission dynamics is crucial for effective infection control strategies within healthcare settings, such as ICUs.

What were the key findings of the Korean study regarding ESBL-E and CRE prevalence and acquisition rates in ICUs?

The Korean study revealed important data on the prevalence and spread of antibiotic-resistant bacteria in ICUs. It found that 28.2% of patients admitted to the ICUs were already carrying ESBL-E, indicating a high pre-existing colonization rate. During their ICU stay, an additional 12.1% of patients who were initially free of ESBL-E acquired it. In contrast, CRE carriage was much lower, with only 0.3% prevalence upon admission. The acquisition rate of CRE during the ICU stay was 2.9%. These findings suggest that ESBL-E is more prevalent and readily acquired in the ICU environment compared to CRE.

Why is it important to monitor ESBL-E and CRE in hospital settings like ICUs?

Monitoring ESBL-E and CRE in hospital settings, especially ICUs, is critical for several reasons. First, it helps healthcare professionals understand the current prevalence and transmission dynamics of these antibiotic-resistant bacteria within their specific environment. This knowledge allows for the implementation and adaptation of effective infection control strategies, such as enhanced hand hygiene, isolation of infected patients, and environmental cleaning protocols. Second, monitoring helps to identify any outbreaks and to track the emergence of new resistance mechanisms, which informs antibiotic stewardship programs and helps guide the appropriate use of antibiotics. Continuous monitoring ensures that healthcare professionals can protect vulnerable patients and safeguard the effectiveness of essential medications.

What implications do these findings have for healthcare professionals and the general public in combating antibiotic resistance?

The findings from the Korean study have significant implications for healthcare professionals and the general public. For healthcare professionals, it underscores the need for continuous monitoring of ESBL-E and CRE, adapting infection control strategies based on local data, and promoting responsible antibiotic use to prevent further resistance. The genetic characteristics of the isolated bacteria is important to understand their relatedness. For the general public, it highlights the importance of practicing good hygiene, such as frequent handwashing, and advocating for responsible antibiotic use in their communities. These findings also reinforce the importance of supporting public health initiatives aimed at curbing the spread of antibiotic resistance, which is a growing global health threat.