Highlights
- • Carbapenem-resistant Gram-negative pathogens are a priority for R&D, according to WHO.
- • Increasing need for new therapies against Klebsiella, Pseudomonasand Acinetobacter.
- • Modified drugs of old classes increase susceptibility rates but some cross-resistance remains.
- • R&D of novel antibiotics without the potential for cross-resistance is needed.
Resistance in Gram-negative bacteria has become a serious problem in many regions of the world as it may reduce the treatment options substantially. Carbapenem-resistance is a good marker for such situations and is most prevalent in Acinetobacter, Pseudomonas but also increasingly in Enterobacteriaceae, especially Klebsiella. This review gives a rough global picture highlighting the epicentres of resistance. The medical need for novel treatment options globally is undeniable even if many countries with good stewardship and infection control conditions are not highly affected. Antibiotic pipelines are encouraging, as new drugs in development reduce the resistance rate to individual pathogens. 
Despite some progress, efforts to discover and develop novel drugs that are not prone to cross-resistance to existing antibiotic classes should be intensified.