Fig. 3.

Intervention measures, their effect on resistance levels, and the most important relations with relevant outcome parameters. The colour scale from yellow to red indicates the need for low- to high-priority research, respectively. Infection prevention measures include hygiene-control and isolation policies in hospitals and vaccination programs in the community and veterinary sector. Antibiotic development implies the need for better technologies in order to develop new antibiotics and alternative strategies. Antibiotic use refers to prudent use in the hospitals, restricted use in the community (i.e. better compliance with the prohibition of over-the-counter sales of antibiotics), and therapeutic use only in the veterinary sector. Standardized evidence-based guidelines and education programs for healthcare professionals and the public are needed to implement intervention measures. Well-designed standardized surveillance programs are needed to study the cost-effectiveness of intervention measures in the hospital, the community, and other resistance reservoirs such as the veterinary sector. Resistance levels, in turn, should be linked to relevant outcome parameters like mortality, morbidity, economic costs of resistance, and cost-effectiveness of intervention measures. Finally, resistance dynamics should be analysed in relation to intervention measures using mathematical modelling, and the spread and mechanisms of resistance should be addressed by coupling resistance data to the genetic background of the strains.