Strong antibiotics create stronger bacteria.
What does that mean?
It means exactly what it says.
When antibiotics are given to treat an infection,
some bacteria may survive because they can withstand the antibiotics.
Eventually,
stronger antibiotics may be used,
and then bacteria that can survive those antibiotics can emerge as well.
It’s almost like
we are using antibiotics to give these microorganisms
special-forces-level training.
No one can predict
what kind of monster the bacteria that survives everything in the end might become.
Today’s subject, CRE, is the same.
CRE refers to Enterobacterales that are resistant to carbapenem antibiotics.
When are carbapenems mainly used?
They are used for infections such as pneumonia, urinary tract infections, meningitis, and sepsis.
So you might easily get scared and think,
“Wait, can’t people get all of those in everyday life?”
But when an infection occurs in everyday life,
it doesn’t necessarily mean carbapenem antibiotics are used right away.
They are important treatments for severe infections, infections that are difficult to treat with existing antibiotics, and multidrug-resistant bacterial infections that occur in healthcare settings.
In other words, they are strong antibiotics that doctors use only after carefully deciding that they are necessary.
A patient is admitted to a hospital → develops pneumonia, sepsis, an intra-abdominal infection, and so on → ordinary antibiotics don’t work or resistance is suspected
The decision is made to use carbapenems
That’s roughly how it works.
If a bacterium is resistant to those carbapenems,
that’s CRE, so it clearly isn’t an ordinary bacterium, right?
If the antibiotics we use become stronger over time
and the types of antibiotics become more diverse,
it may become difficult to reduce the number of CRE infections or deaths caused by CRE.
The number of long-term hospitalized patients is not suddenly going to decrease this year either,
and CRE can be particularly dangerous for older patients.
That makes the situation even more significant in an aging society like ours.
So, is that really what is happening?
Let’s take a look at the graph.
I made this table using data from the Korea Disease Control and Prevention Agency.
What do you think?
It goes up year after year, almost perfectly, doesn’t it?
If only that had been my stock…
There were 944 deaths from CRE in South Korea in 2025 alone.
Maybe that joke wasn’t very appropriate.
944 deaths.
Then how many people were reported with CRE, and what was the death rate?
| Age | 2025 CRE reported cases | Share | Deaths |
|---|---|---|---|
| 70 and older | 34,121 | 69.6% | 605 |
| 60 and older | — | — | 801 |
| Under 60 | — | — | 143 |
| Total | 49,053 | 100% | 944 |
Let’s put it simply.
There were a total of 49,053 reported CRE cases.
And among them, people aged 60 and older accounted for
nearly 86.5% of the total.
That means about 42,432 people were aged 60 or older,
and among them,
801 died.
That accounts for
84.9% of all CRE deaths.
Huh… what’s going on?
You might wonder how CRE seems to be spreading among older people almost exclusively.
But there is another way to look at this.
It’s the classic question:
Which came first, the chicken or the egg?
As I mentioned earlier,
carbapenem antibiotics, which are important in treating CRE-related infections,
are generally not used as the first choice for ordinary infections in everyday life.
Instead, they may be used for patients who have been hospitalized for a long time
when an additional infection develops
or when the usual antibiotics no longer work.
If a patient has already been given antibiotics
or develops an additional infection,
where is that most likely to happen?
In a hospital, right?
In the end, it could also be interpreted as CRE occurring among older people whose immune defenses have weakened
because they have been hospitalized for a long time.
As technology advances,
there are also side effects that come with it.
I never expected this particular consequence of medical progress to emerge this way.
Then again.
Maybe we simply chose to look away from it.
After all, we still have to use antibiotics if we want to save people’s lives.
Perhaps the final battle for the survival of humanity
will not be
people fighting against people,
but a war between humans and bacteria.