Emerging and re-emerging infectious diseases: a continuous challenge for Europe.

The growing problem of antibiotic resistance represents a major health burden for the EU. For example, carbapenems are the major last-line class of antibiotics to treat infections with multidrug-resistant (MDR) Gram-negative bacteria such as Klebsiella pneumoniae (a frequent cause of pneumonia and urinary tract infections in hospitals). 15–50% of K. pneumoniae from bloodstream infections are resistant to carbapenems in the EU [4]. Another example is Staphylococcus aureus, a bacterium that can cause a variety of infections (from minor skin infections to severe pneumonia). Its adaptation has led to an MDR pathogen, methicillin-resistant S. aureus (MRSA). MRSA is associated with severe invasive disease. Initially, MRSA was only a nosocomial pathogen, but in the last 20 yrs it has been identified in the community (community-associated (CA)MRSA) [5]. The incidence of CA-MRSA pneumonia is estimated at 0.51–0.64 cases per 100,000 population. Since the incidence of community-acquired pneumonia (CAP) is between 100 and 1,000 per 100,000 population [6], the frequency of CA-MRSA pneumonia can be estimated to be between one in 200 and one in 2,000 cases of CAP [5]. CA-MRSA pneumonia is a severe disease with 75–85% of affected patients being admitted to the intensive care unit and 20–60% dying [7].