An estimated 1.14 million people worldwide died in 2021 from infections caused by antibiotic-resistant bacteria. However, because outbreak scales, transmission patterns, and clinical environments vary significantly by country, global priority lists—such as those published by the World Health Organization (WHO)—often fail to accurately reflect domestic healthcare realities.
To address this gap, a research team led by Professors Kim Jeong-yeon and Yoon Young-kyung of the Division of Infectious Diseases at Korea University Anam Hospital conducted South Korea's first systematic risk assessment of 17 major antibiotic-resistant pathogens, establishing a tailored, national-level response framework.
Multi-Criteria Framework Tailored to Domestic Healthcare
The research team selected 17 resistant pathogens by combining national resistance surveillance data, clinical records from five university hospitals, academic literature, and expert consensus. Using multi-criteria decision analysis (MCDA), 56 experts—including specialists in infectious diseases, pediatrics, pharmacy, and health policy—evaluated each pathogen across eight criteria: incidence, in-hospital mortality, disease burden, rising resistance trends, transmissibility, preventability, treatability, and pipeline prospects for new therapeutics.
Based on the aggregated scores, the 17 pathogens were categorized into three tiers: three in the highest-risk "urgent response" group, seven under "priority management," and seven under "monitoring."
The three "urgent response" pathogens identified were carbapenem-resistant Klebsiella pneumoniae, carbapenem-resistant Acinetobacter baumannii, and vancomycin-resistant Enterococcus faecium (VRE). While carbapenem-resistant K. pneumoniae and A. baumannii align with the top tier of the WHO’s 2024 global priority list, vancomycin-resistant enterococci sits in a lower tier globally but emerged as an urgent top-tier threat in South Korea—underscoring the necessity of evaluations based on local epidemiological data.
"This study is significant because it goes beyond simply ranking domestic pathogens by risk," said Professor Kim Jeong-yeon. "It establishes a structured framework that considers multiple critical factors simultaneously, including mortality risk, transmissibility, overall disease burden, and treatability."
Professor Yoon Young-kyung emphasized the policy implications, stating, "In responding to antibiotic resistance, prioritizing pathogens that pose higher risks under domestic conditions is far more effective than distributing resources equally. We expect this study to serve as scientific evidence for setting national priorities in infection control, surveillance, appropriate antibiotic stewardship, and therapeutic R&D."
The team noted that the framework is designed to be dynamic rather than static. If new resistant strains emerge, case numbers shift, or novel therapeutics become available, national priorities can be recalculated using updated data. Supported by the Korea Disease Control and Prevention Agency’s National Institute of Health, the multidisciplinary study was published in the September 2026 issue of The Lancet Regional Health – Western Pacific.
