Background: Surveillance studies are mandatory to carefully monitor changing trends in Europe. Methods: Surveys on antibiotic resistance conducted in European hospitals were reviewed. Data were obtained from own studies, through searches of Medlines, Pubmed, abstracts and posters presented at meetings, from the World Wide Web and from surveillance studies conducted by the pharmaceutical industry. Results: A high prevalence of MRSA was found in most European hospitals, except in northern Europe, and an increasing trend in non-intensive care unit patients was observed. In most European hospitals, the prevalence of infections caused by vancomycin-resistant enterococci remains very low and most outbreaks have occurred in at-risk wards. No major changes of resistance among Enterobacteriaceae were observed. Very few of the major antibiotics are now reliably effective for the treatment of severe nosocomial carbapenem-resistant Acinetobacter infections. Conclusions: Although antimicrobial resistance appears to be increasing all over Europe, it is difficult to accurately estimate the extent of this emerging problem. One of the main reasons for this can be attributed to the fact that the published susceptibility data are difficult to compare due to the different methods used, population bias, and clonal variation. Increasing antimicrobial resistance necessitates a critical appraisal of the remaining antibiotic treatment options.