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Carbapenemase-producing Enterobacteriaceae (CPE) are extremely multiresistant bacteria with few or no treatment options. Infections with CPE are associated with a mortality of 40-50%. In Denmark, CPE were first detected in 2008. Prior to 2013 the CPE incidence was low, but since then the incidence has increased significantly. Seven outbreaks have occurred, and at least 25 patients have been infected or colonized. The rise in CPE incidence emphasizes the need for a national intervention to reduce the spread. This can be obtained through systematic surveillance, infection control and reduction of antibiotic consumption.

This review describes the recent epidemiology for MRSA and ESBL-producing Enterobacteriaceae in Denmark. MRSA community-associated cases continue to increase whereas hospital associated cases are low and stable. Due to an active search and destroy policy secondary transmission is modest. MRSA from pigs is an increasing problem. For ESBL producing Escherichia coli a considerable multi clonal increase has been seen both in the community and in hospitals. There are indications on food being a significant reservoir. For ESBL producing Klebsiella pneumoniae an increasing number of hospital outbreaks have been observed.

The frequency of multi resistant bacteria (MRB) is also increasing in Denmark. This creates problems in hospitals as well as in primary health care. This paper focuses on the increase in MRSA and resistance against beta-lactams and quinolones in Enterobacteriaceae, including infection control measures against the transmission of these bacteria. The increase in MRB is a direct threat against the Danish antibiotic policy and MRB should continuously be handled without hesitation.