Introduction:
In the last years Klebsiella pneumoniae (K. pneumoniae) showed worrying levels of antibiotic resistance with significant differences between countries. We used the Drug Resistance Index (DRI) with the aim to identifying antibiotic effectiveness differences in the European Region.

Materials and Methods:
We calculated, and compared K. pneumonia related DRI in Italy, France, and Spain for the years 2009, 2011, 2013, and 2015. DRI was calculated by multiplying proportion of consumption of selected antibiotic class and proportion of all K. pneumoniae resistant to that antibiotic class. Prevalence of resistance data were obtained by consulting the national surveillance system (Italy), and the ECDC surveillance system (France and Spain). Antibiotic consumption data were extrapolated from the Italian Medicines Agency (Italy) and the Center for Disease Dynamics, Economics and Policy system (France and Spain).

Results:
Among the classes of antibiotics considered, the highest prevalence of resistance in Italy was for Cephalosporins; the lowest for Carbapenems. The highest prevalence of resistance in France and Spain was for Fluoroquinolones; the lowest for Carbapenems. In Italy and Spain, the higher consumption was recorded for Fluoroquinolones. In France the consumption of Cephalosporins was the highest. DRI was different in the countries considered, however the trend was similar: increase from 2009 to 2013 and stabilization in 2015. Italian DRI was 27.4% in 2009 and increased in the following years (45.3% in 2011; 54.0% in 2013; 53.8% in 2015). Spanish DRI was 13.2% in 2009, increasing to 14.9% in 2011, and 20.2% both in 2013, and 2015. French DRI increased throughout the period considered: 20.6% in 2009 to 26.0% in 2011, 28.2% in 2013 and 30.0% in 2015.

Conclusions:
Regional and temporal differences in DRI suggest the need for international action to face antibiotic resistance.