Antimicrobial resistance (AMR) is increasing worldwide, presenting substantial challenges to the prevention and treatment of common bacterial infections.1, 2 This resistance results in worse and more costly health outcomes3, 4 and an increased risk of morbidity and mortality.5, 6, 7 In Europe, resistance has been reported for every major class of antibiotic in both community and health-care settings.8 Various factors might be contributing toward onward transmission of resistance, including travel, migration, and socioeconomic factors.9, 10, 11, 12, 13

In Europe, combined resistance to fluoroquinolones, third-generation cephalosporins, and aminoglycosides increased between 2011 and 2014 in isolates for Gram-negative bacteria, including Klebsiella pneumoniae (from 16·7% to 19·6%) and Escherichia coli (from 3·8% to 4·8%).6 In England, bloodstream infections caused by E coli resistant to the most frequently used antibiotics for sepsis (eg, piperacillin–tazobactam) increased from 8·5% to 11·7% between 2011 and 2015; resistant K pneumoniae increased from 12·6% to 18·5% in the same period.14 These changes will result in an…………see more