Korea’s first government-led pilot program on antimicrobial stewardship has been detailed in JAMA Network Open, in a paper that outlines the policy background, design, operational framework, early implementation results and limitations of the initiative.
The paper, published online on Jan. 29, focuses on Korea’s nationwide Antimicrobial Stewardship Program, or ASP, which began in November 2024. According to the paper and a press release from Seoul National University Bundang Hospital (SNUBH), the project is the first case of a government-led pilot standardizing and institutionalizing hospital antimicrobial stewardship at a national level through an integrated framework of policy, financing and evaluation.
The paper was led by Professor Kim Hong-bin, a specialist in infectious diseases, vaccination and antibiotic resistance at SNUBH, who also serves as chairperson of the Korean Society of Infectious Diseases. Professor Lee Hyun-ju of pediatrics and Professor Moon Song-mi, an infectious disease specialist overseeing opportunistic infections in immunocompromised patients at the hospital, were co-first authors. Government officials and clinical policy experts also contributed to the report.
Antimicrobial resistance remains a growing public health threat. The World Health Organization (WHO) has identified it as one of the world’s top public health risks.
In Korea, antibiotic use reached 31.8 defined daily doses per 1,000 inhabitants in 2023, above the OECD average of 19.5, according to the hospital. The paper said frequent use of broad-spectrum antibiotics has contributed to a higher risk of treatment failure and rising antimicrobial resistance rates.
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From left, Professor Kim Hong-bin, a specialist in infectious diseases, vaccination and antibiotic resistance, Professor Lee Hyun-ju of pediatrics, and Professor Moon Song-mi, an infectious disease specialist overseeing opportunistic infections in immunocompromised patients, at Seoul National University Bundang Hospital (SNUBH). (Courtesy of SNUBH)
The pilot program was launched as a key initiative under Korea’s second national action plan on antimicrobial resistance. It targets general and tertiary hospitals with more than 300 beds and aims to establish antimicrobial stewardship within hospitals by integrating government policy, financial support and evaluation systems. Seventy-eight hospitals were selected for the first phase, and additional hospitals are to be recruited annually through 2027.
The program requires participating hospitals to establish multidisciplinary ASP teams, introduce standardized audit-and-feedback and data-based monitoring systems, and operate under a performance-linked financial support structure. The goal is to encourage hospitals to carry out antibiotic-use surveillance and prescribing improvement activities in a systematic way.
Early implementation data suggested participating hospitals moved quickly to build core systems. A survey conducted in January and February 2025, about three months after the launch, found that more than half of participating hospitals had formed antimicrobial stewardship committees, while more than 80 percent had developed and implemented antibiotic-use guidelines. All participating hospitals were operating approval programs for selected antibiotics, and more than 30 percent had begun directly monitoring prescription appropriateness.
The paper also pointed to continuing challenges, including differences in readiness among hospitals, shortages of trained personnel and limited understanding of ASP among some clinicians and public health stakeholders. It said those barriers were especially pronounced in non-university and smaller hospitals, where structural resource constraints and limited experience have hindered implementation.
Professor Kim said the rapid establishment of a nationwide antimicrobial stewardship infrastructure was encouraging, but that staffing shortages and capability gaps between tertiary and smaller hospitals remained unresolved. He said the next step should include expanding the project to smaller hospitals and long-term care hospitals and building regional networks in which larger hospitals support smaller institutions.
SNUBH said its own experience played a key role in shaping the pilot. The hospital said it had been carrying out ASP activities since 2013, before the national pilot began, and had trained specialists through an infectious disease pharmacist program while maintaining antibiotic intervention efforts through collaboration between physicians and pharmacists.
According to the hospital, its antibiotic use has remained more than 15 percent below the average for hospitals with a similar number of beds, while carbapenem use has stayed about 30 percent below average.
The hospital said that experience was reflected in the pilot’s planning and that it had also supported participating institutions in trying to reduce early implementation difficulties and establish ASP activities more quickly.
Source: https://www.koreabiomed.com/news/articleView.html?idxno=30844
