Ready for a world without antibiotics? The Pensières Antibiotic Resistance Call to Action

In the golden age of the discovery of antibiotics, these potent "miracle" drugs saved millions of lives. In contrast, we are entering an era where bacterial infections, such as bloodstream infections and ventilator-associated pneumonia, might no longer be successfully treated with antibiotics [1]. We now face a dramatic challenge resulting from two combined problems. First, microorganisms are becoming extremely resistant to existing antibiotics, in particular Gram-negative rods (e.g., Escherichia coli, Salmonella spp, Klebsiella spp, Pseudomonas aeruginosa, Acinetobacter spp), which are resistant to almost all currently available antibiotics in some settings. Resistance can be combined with virulence, acting as a potentially deadly duo, as observed in the recent large epidemic outbreak of E. coli 0104:H4 in Europe, notably in Germany [2]. Second, the antibiotic pipeline has become extremely dry [3]. Several new powerful compounds active against Gram-positive cocci have been made available in the last few years, but this is not the case for Gram-negative bacteria and almost no new antibiotic class active against multiresistant Gram-negative rods can be anticipated in the near future. Although hard to imagine, the reality is that many clinicians will soon face a therapeutic dead end in the treatment of certain types of severe bacterial infections. This worrisome situation takes us back to the pre-antibiotic era of the 1930s and early 1940s [1,3,4]. We cannot look at this evolving and pandemic threat passively and lose one of the most important drugs discovered in the previous century. We must act now; silence is not an answer.In this position paper, we summarize important messages and conclusions from the 3rd World Healthcare-Associated Infections (HAI) Forum held in June 2011. The meeting gathered together 70 leading world experts and opinion leaders in the domain of antimicrobial resistance (AMR) from 33 countries to discuss the challenges and possible options to ta