Research and analysis

Carbapenemase-producing Gram-negative organisms in England since October 2020: quarterly update, Q1 2024

Updated 26 September 2024

Applies to England

Main messages

Main messages from this report are as follows:

• the quarterly rate of reported CPO episodes decreased this quarter compared to last quarter, from 3.1 per 100,000 population in Q4 2023 to 2.7 per 100,000 population in Q1 2024
• reporting of sterile site specimens decreased in Q1 2024 compared to Q4 2023; however, these two quarters saw the highest number of sterile site specimens reported since mandatory surveillance began in Q4 2020
• the most commonly reported CPO mechanism in the last year (Q2 2023 to Q1 2024) was OXA-48-like (35.8%), followed by NDM (35.3%) and KPC (20.9%), however this varied by region; in London and the North west NDM and KPC were most commonly reported respectively
• no change was reported in the demographic groups (by age and sex, region, ethnic group and IMD decile) with the highest rates of CPO episodes in Q1 2024 compared to Q4 2023

Background

Since 1 October 2020, all diagnostic laboratories in England have a duty to notify the following via the UK Health Security Agency (UKHSA)’s Second Generation Surveillance System (SGSS) (1):

• acquired carbapenemase-producing Gram-negative organisms identified in human samples
• the results of any antimicrobial susceptibility test and carbapenem resistance mechanism in any of the causative agents listed in Schedule 2 of the Health Protection (Notification) Regulations 2020 (1).

This requirement was launched in conjunction with the national Framework of actions to contain carbapenemase-producing Enterobacterales (CPE), which sets out a range of measures that, if implemented well, will help health and social care providers minimise the impact of carbapenemase-producing organisms (CPO).

The analyses below are based on data relating to notifications of confirmed acquired CPOs between 1 October 2020 and 31 March 2024 in England. The data was extracted on 16 May 2024 from both UKHSA’s voluntary surveillance database, SGSS, and the Antimicrobial Resistance and Healthcare-Associated Infections (AMRHAI) Reference Unit database.

Both annual and quarterly rates of acquired CPOs were calculated using mid-year resident population estimates for the respective year and geography. Geographical analyses were based on the patient’s residential postcode. Where this information was unknown, the postcode of the reporting laboratory was used. Cases in England were further assigned to one of 9 local areas, formed from the administrative local authority boundaries. The annual rates of acquired CPOs by geographical region reported in this report differ slightly from those calculated in some previous reports due to a methodological adjustment (following the identification of an inconsistency in previous reports’ methodology). Previous reports will be corrected accordingly.

Samples are split into three specimen types: sterile site specimens (e.g. blood or cerebrospinal fluid), screening site specimens (e.g. faeces or lower gastrointestinal tract) or ‘other’ specimen type (e.g. urine or lower genital tract). As patients may have more than one positive specimen taken, specimens taken from the same patient that yielded growth of the same pathogen, had the same carbapenemase gene and were from the same specimen type within a 52-week period from the initial positive specimen were regarded as comprising the same episode and were de-duplicated. CPO referred isolates and local laboratory isolates were combined for this de-duplication process, with resistance mechanism results from the AMRHAI Reference Unit retained preferentially where patient specimen overlap occurred (please note, not all specimens in this report are confirmed by the AMRHAI Reference Unit). This method differs slightly from weekly causative agent notification data where data is not de-duplicated incorporating specimen type. In addition, the data presented in the weekly notification reports utilises SGSS reports only.

The index of multiple deprivation (IMD) is a way of summarising the level of deprivation within an area, based on a set of factors that includes their levels of income, employment, education and local levels of crime. Episodes were linked to IMD using patient postcode (and GP or laboratory postcode where patient postcode was unavailable) and the IMD decile score was identified by the lower super output area the patient resided in.

The Office for Health Improvements and Disparities developed a method for assigning ethnic group based on hospital admissions data. As different ethnicities may be recorded in different treatment episodes, the method selected a single ethnic group from a patient’s HES records. Episodes were linked to ethnic group using patient NHS number and date of birth.

The following report summarises trends and geographical distribution of carbapenemase mechanisms identified from Gram-negative bacteria in human samples. Species, mechanism, sample type, and age and sex of patients are also described. For the purposes of this report, quarters are calendar quarters, as such January to March is referred to as ‘Q1’, April to June is referred to as ‘Q2’, July to September is referred to as ‘Q3’ and October to December is referred to as ‘Q4’, alongside relevant years.

Note: Scientific names are not italicised in this report to ensure our content is inclusive for all users and in compliance with web accessibility legislation and associated guidelines.

Microbiology services

For reference services, including species identification and confirmation of susceptibility testing results, laboratories should contact UKHSA’s Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit in Colindale, London.

Table 1 summarises the carbapenemase gene families that are targeted – using the routine polymerase chain reaction (PCR) applied to referred Enterobacterales, Pseudomonas spp. and Acinetobacter spp. – because they are suspected of harbouring an acquired carbapenemase gene. UKHSA strongly recommends that all diagnostic laboratories are able to detect, at least, the 4 carbapenemase families shown in bold in this table (the ‘big 4’) using either PCR or immunochromatographic methods.

Where an ‘exceptional’ carbapenemase and genus combination result (cells without a ¥ symbol in Table 1) has been identified, or where an unusual organism has been identified with an acquired carbapenemase (that is, any bacterial genera other than a member of the Enterobacterales, Pseudomonas spp. or Acinetobacter spp.), isolates should be sent to the AMRHAI Reference Unit for confirmation.

Table 1. Distribution of carbapenemase genes covered by AMRHAI Reference Unit molecular assay (based on AMRHAI data) [note 1]

Carbapenemase family	Associated with common ‘host’ organism Enterobacterales	Associated common ‘host’ organism Pseudomonas spp.	Associated with common ‘host’ organism Acinetobacter spp.
KPC	¥	<10D	<10D
OXA-48-like	¥	<10D	0
NDM	¥	¥	¥
VIM	¥	¥	<10D
IMP	¥	¥	¥
IMI/NMC-A	¥B	0	0
GES	¥	¥	<10D
FRI	<10	0	0
SME	¥C	0	0
DIM	0	<10D	0
GIM	<10D	<10D	0
SIM	0	<10D	0
SPM	0	<10D	0
OXA-23-like	<10D	0	¥
OXA-40-like	0	0	¥
OXA-51-likeA	0	0	¥
OXA-58-like	0	0	¥

View this table in the data tables file

Notes to Table 1

Note 1. Table 1 uses the following symbols:

¥ = combinations of mechanism and genus would not be considered as exceptional results.

A = intrinsic to A. baumannii and only expressed when associated with an insertion element.

B = almost exclusively reported in Enterobacter spp. with less than a handful of reports in other genera.

C = reported only in Serratia marcescens.

D = fewer than 10 in total ever referred to AMRHAI Reference Unit.

Recent developments

Unusual acquired CPOs referred to the AMRHAI Reference Unit in Q1 2024  consisted of one isolate of Escherichia coli positive for OXA-23 from a rectal swab in London; this is only the second such isolate we have identified and genomic characterisation is underway to compare to the first isolate from 2022 in the East Midlands (2). A further two Enterobacterales isolates positive for both KPC and NDM were identified: one Enterobacter cloacae complex isolated from sputum in Yorkshire & Humberside and one E. coli isolated from a rectal swab in the North West. Isolates positive for these two carbapenemases are currently rare amongst AMRHAI submissions with only 13 isolates previously identified with both KPC and NDM.

Locally-confirmed unusual combinations of organism and mechanism should be referred to the AMRHAI Reference Unit for confirmation. Follow up of these unusual combinations has identified some have been due to mixed cultures or reporting errors.

Specimen type

Between October 2020 and March 2024, there were 14,653 acquired CPO episodes reported. The majority were identified in screening samples, accounting for 71.5% of notifications, with only 4.6% reported in sterile site specimens (Table 2).

Table 2. Number and percentage of acquired CPO episodes by specimen type (England): October 2020 to March 2024

Specimen type	All reports number	All reports % [note 3]	From AMRHAI number	From AMRHAI % [note 4]
Sterile site samples	672	4.6	236	10.8
Screening samples	10,484	71.5	1,041	47.4
Other samples [note 2]	3,497	23.9	917	41.8
All samples	14,653	100.0	2,194	100.0

View this table in the data tables file.

Notes to Table 2

Note 2. Samples that do not fall into either ‘sterile site’ or ‘screening’ samples, for example, urine and lower genital tract specimens.

Note 3. The percentages presented in this table are column percentages, with the breakdown of specimen types shown for all reports and AMRHAI reports separately.

Note 4. The AMRHAI Reference Unit actively encourages submission of sterile site isolates for carbapenemase confirmation; the distribution of specimen type will reflect this.

Quarterly trends

The overall annual rate of CPO episodes in England was 10.7 per 100,000 population. While there has been an overall increase in CPO episodes since Q4 2020, the quarterly rate of CPO episodes (quarterly number of episodes over the annual population) decreased this quarter, from 3.1 per 100,000 population in Q4 2023 to 2.7 per 100,000 population in Q1 2024. This decline was predominantly due to decreases in rates among ‘other’ and screening sample types (Figure 1). There was a small decrease in the rate of CPO episodes in sterile site samples in Q1 2024 compared to Q4 2023, however this followed a steady increase in the rate of CPO episodes in sterile site samples since Q2 2022 (Figure 1), with the number of reported sterile site infections nearly doubling from Q4 2020 to Q1 2024 (see accompanying data tables).

Changes to screening policies, outbreaks, and/or an improvement in national reporting of CPO episodes can have a substantial impact on overall CPO trends; it is therefore important to note that this may not necessarily represent a change in clinical infections as screening policies change and national reporting improves over time. Furthermore, as there are only 14 quarters of notification data, it is too early to conclude that there may be any seasonality, particularly in light of the COVID-19 pandemic, where quarterly changes may be affected by the COVID-19 pandemic during this period or associated with local CPO outbreaks.

Figure 1. Quarterly rate of acquired CPO episodes by specimen type and quarter (England): October 2020 to March 2024

Geographic distribution

The data summaries presented in the rest of this report consider all samples grouped together and only for the past year.

The annual rate of acquired CPO episodes varied by region (Office for National Statistics [ONS] regions) (Figure 2), with the highest overall rate between April 2023 and March 2024 reported in London (21.7 episodes per 100,000 population), followed by the North West region (20.5 episodes per 100,000 population). The lowest annual incidence across the last year was reported in the South West region (2.0 episodes per 100,000 population).

Figure 2. Geographical distribution of acquired carbapenemase-producing organism annual incidence rates per 100,000 population (England): April 2023 to March 2024 [note 5]

Notes to Figure 2

Note 5. The region geography is based on the patient’s residential postcode (if unknown, laboratory location was used) and linked to the ONS data for regions.

The number and quarterly rate of reported acquired CPO episodes for each ONS region by calendar quarter is shown in Table 3. The quarterly rate of reported CPO episodes in ONS regions decreased from Q4 2023 to Q1 2024 in most regions. The largest decrease in rate was seen in the West Midlands, where the quarterly rate decreased from 4.7 per 100,000 population in Q4 2023 to 3.4 per 100,000 population in Q1 2024.

Table 3. Number of acquired CPO episodes and quarterly rate per 100,000 population for all specimen types by ONS region (England): April 2023 to March 2024

ONS region	Q2 2023 number	Q2 2023 rate	Q3 2023 number	Q3 2023 rate	Q4 2023 number	Q4 2023 rate	Q1 2024 number	Q1 2024 rate
East Midlands	46	0.9	51	1.0	79	1.6	61	1.2
East of England	33	0.5	55	0.8	71	1.1	74	1.1
London	450	5.1	522	5.9	478	5.4	477	5.4
North East	38	1.4	101	3.8	92	3.4	77	2.9
North West	349	4.6	404	5.4	423	5.6	365	4.9
South East	71	0.8	75	0.8	140	1.5	109	1.2
South West	17	0.3	34	0.6	37	0.6	30	0.5
West Midlands	200	3.3	253	4.2	284	4.7	202	3.4
Yorkshire and The Humber	74	1.3	93	1.7	133	2.4	127	2.3

Geographical differences in carbapenemase family

Between April 2023 and March 2024, the most common carbapenemase families reported across all regions were OXA-48-like (35.8%), NDM (35.3%), and KPC (20.9%). However, the distribution of carbapenemase families identified varied regionally (Figure 3).

In London, which had the highest annual incidence rate, the most commonly reported carbapenemase families identified were NDM (47.9%) and OXA-48-like (39.2%). However, in the North West, which also had a high annual incidence rate, KPC accounted for 45.2% of episodes. KPC was not as common in any of the other regions, accounting for fewer than 33.4% of episodes in each region; in London, KPC accounted for 3.8% of episodes.

Another regional difference was reported in the North East and Yorkshire and Humber, where IMP was more commonly reported compared to any of the other regions, accounting for 14.9% and 11.5% of episodes, respectively (other regions reporting fewer than 9.1%). However, given the small number of carbapenemases reported in some regions, the diversity of carbapenemases reported is likely to be strongly impacted by individual outbreaks. In the two regions that had the lowest annual incidence rates, the most common carbapenemase family was OXA-48-like (63.1% in the East of England and 46.6% in the South West).

The distribution of carbapenemase families within each ONS region also varied by quarter. For example, the most commonly reported carbapenemase family identified in the Yorkshire and The Humber was predominantly OXA-48-like in Q1 2024 (31.5%) but in Q2 2023 it was predominantly NDM (37.8%).

Figure 3. Geographical distribution of acquired CPO episodes by carbapenemase family (England): April 2023 to March 2024

Notes to Figure 3

Note 6. Other carbapenemase families include DIM, GES, GIM, IMI, OXA-23 (in genera other than Acinetobacter spp.).

Distribution of species and carbapenemase family

Between April 2023 and March 2024, the most frequently isolated Gram-negative bacterial species with a confirmed acquired CPO was Escherichia coli, accounting for 33.4% of all specimens. This was followed by Klebsiella pneumoniae, and Enterobacter spp., which accounted for 30.3% and 19.3% of all specimens, respectively (Table 4).

The carbapenemase family most frequently identified in E. coli and K. pneumoniae isolates was OXA-48-like (43.5% and 37.7%, respectively), followed by NDM and KPC (42.9% and 11.4%, and 30.2% and 27.1%, respectively). In Enterobacter spp. isolates the most common carbapenemase family was NDM (37.6%), followed by KPC and OXA-48-like (22.8% and 22.7%, respectively).

Aside from the ‘big 5’ carbapenemase families (KPC, OXA-48-like, NDM, VIM and IMP), the AMRHAI Reference Unit also screens for rarer carbapenemase families, and it is recommended that all isolates suspected to produce an acquired carbapenemase but are negative for the ‘big 4/5’ carbapenemase families (depending on the testing capabilities of the local laboratory) are referred to the AMRHAI Reference Unit for further testing. Between October 2020 and March 2024, DIM, GES, GIM, IMI, OXA-23 and SME carbapenemases were identified in small numbers (1,31, 8, 34, 8 and 2, respectively), with only five isolates (GIM positive) being identified from invasive specimens.

Table 4. Acquired CPO episodes by species and carbapenemase family (England): April 2023 to March 2024

Species	IMP number (%)	KPC number (%)	NDM number (%)	OXA-48-like number (%)	VIM number (%)	Other number (%)	Total number	% of Total per species
Acinetobacter spp. [note 7]	5  (8.6)	1  (1.7)	48 (82.8)	2  (3.4)	2  (3.4)	0  (0.0)	58	0.9
Citrobacter spp.	18  (5.6)	68 (21.2)	73 (22.7)	152 (47.4)	9  (2.8)	1  (0.3)	321	5.2
Enterobacter spp.	160 (13.5)	269 (22.8)	445 (37.6)	268 (22.7)	29  (2.5)	11  (0.9)	1,182	19.3
Escherichia coli	31  (1.5)	233 (11.4)	878 (42.9)	890 (43.5)	16  (0.8)	0  (0.0)	2,048	33.4
Other Escherichia spp.	1  (6.3)	12 (75.0)	1  (6.3)	2  (12.5)	0  (0.0)	0  (0.0)	16	0.3
Klebsiella oxytoca	4  (1.8)	131 (58.0)	17  (7.5)	69 (30.5)	5  (2.2)	0  (0.0)	226	3.7
Klebsiella pneumoniae	43  (2.3)	503 (27.1)	561 (30.2)	699 (37.7)	48  (2.6)	1  (0.1)	1,855	30.3
Other Klebsiella spp.	3  (3.4)	23 (25.8)	18 (20.2)	43 (48.3)	2  (2.2)	0  (0.0)	89	1.5
Morganella spp.	0  (0.0)	1  (5.9)	4  (23.5)	10 (58.8)	2  (11.8)	0  (0.0)	17	0.3
Pseudomonas aeruginosa [note 7]	15 (11.5)	1  (0.8)	57 (43.8)	4  (3.1)	45 (34.6)	8  (6.2)	130	2.1
Other Pseudomonas spp. [note 7]	1  (3.6)	1  (3.6)	9  (32.1)	0  (0.0)	17 (60.7)	0  (0.0)	28	0.5
Serratia spp.	0  (0.0)	0  (0.0)	13 (41.9)	18 (58.1)	0  (0.0)	0  (0.0)	31	0.5
Other Enterobacterales [note 8]	6  (4.9)	38 (31.1)	39 (32.0)	38 (31.1)	1  (0.8)	0  (0.0)	122	2.0
Other Gram-negative bacteria [note 9]	0  (0.0)	0  (0.0)	1 (100.0)	0  (0.0)	0  (0.0)	0  (0.0)	1	0.0
Total	287 (4.7)	1,281 (20.9)	2,164 (35.3)	2,195 (35.8)	176 (2.9)	21 (0.3)	6,124	100.0

View this table in the data tables file.

Notes to Table 4

Note 7. KPC and OXA-48-like in Pseudomonas spp. and OXA-48-like in Acinetobacter spp. are extremely rare, and results should be interpreted with caution. The numbers reported here have not all been confirmed by the AMRHAI Reference Unit and laboratories identifying these unusual combinations should be referring such isolates to AMRHAI.

Note 8. Includes coliform, Cronobacter spp., Hafnia spp., Kluyvera spp., Leclercia adecarboxylata, Lelliottia amnigena, Mixta calida, Pantoea spp., Phytobacter ursingii, Pluralibacter gergoviae, Proteus spp., Providencia spp., Raoultella spp., and Shigella spp.

Note 9. The numbers reported here have not all been confirmed by the AMRHAI Reference Unit and laboratories identifying these unusual combinations should be referring such isolates to AMRHAI.

Distribution of demographic risk factors

Between April 2023 to March 2024, the annual rate of reported acquired CPO episodes was highest among the oldest and youngest members of the population. A similar age pattern was noted for both sexes, although overall the annual rate was higher in males compared to females (overall rates of 11.9 and 9.5 episodes per 100,000 population, respectively: Figure 4). This aligns with the age group and sex distribution noted in previously published reports on Gram-negative bacteraemia such as E. coli, Klebsiella spp., P. aeruginosa and Enterobacter spp.

Figure 4 shows the reported acquired CPO annual incidence rates by age group between April 2023 to March 2024, with the highest annual rate reported in those 85 years and over (62.3 per 100,000 population) followed by those aged 75 to 84 years (37.0 per 100,000 population). For infants less than one year old, the CPO annual incidence rate was 10.7 per 100,000 population

Figure 4. Annual rate [note 10] of acquired CPO episodes per 100,000 population by age and sex [note 11] (England): April 2023 to March 2024

Notes to Figure 4

Note 10. Rates have been calculated using cumulative reports across the last 4 quarters of reporting and, as such, cannot be compared to previous quarters (3).

Note 11. Information about patient sex is only recorded in 99.4% of cases.

Figure 5 shows the reported acquired CPO annual incidence rates by ethnic group and sex between April 2023 to March 2024, with the highest annual rate reported in those of Asian or Asian British ethnicity (17.6 per 100,000 population), followed by those of Black, Black British, Caribbean or African ethnicity (13.0 per 100,000 population). A similar pattern was noted for both sexes, although overall the annual rate was higher in males compared to females (overall rates of 10.3 and 8.4 episodes per 100,000 population, respectively: Figure 5).

Figure 5. Annual rate [note 10] of acquired CPO episodes per 100,000 population by sex [note 11] and ethnic group [note 12] (England): April 2023 to March 2024

Notes to Figure 5

Note 10. Rates have been calculated using cumulative reports across the last four quarters of reporting, and as such cannot be compared to previous quarters (3).

Note 11. Information about patient sex is only recorded in 99.4% of cases.

Note 12. Information about patient ethnicity in only recorded in 86.5% of cases.

Between April 2023 and March 2024, the most common carbapenemase families reported across those with ethnicity information were OXA-48-like (36.4%), NDM (33.2%), and KPC (22.6%)  (Figure 6). Similar to regional distribution, the distribution of carbapenemase families identified also varied across ethnic groups. In those of Asian or Asian British ethnicity, who had the highest annual incidence rate, the most common carbapenemase families identified were NDM (56.7%) and OXA-48-like (33.2%). KPC was not as common in those of Asian or Asian British ethnicity (7.0%); however in those of White ethnicity, KPC accounted for 27.4% of episodes.

Figure 6. Distribution of acquired CPO episodes by ethnic group [note 12] and carbapenemase family (England): April 2023 to March 2024

Notes to Figure 6

Note 6. Other carbapenemase families include DIM, GES, GIM, IMI and OXA-23 (in genera other than Acinetobacter spp.).

Note 12. Information about patient ethnicity in only recorded in 86.5% of cases.

Figure 7 shows the acquired CPO annual incidence rates by IMD decile and sex between April 2023 to March 2024. The highest annual rate was reported in those in the most deprived decile (15.8 per 100,000 population). The annual rate generally declines as the IMD decile increases, with the lowest annual rate reported in the least deprived IMD decile (6.0 per 100,000 population). A similar pattern was noted for both sexes, although overall the annual rate was higher in males compared to females (overall rates of 6.8 and 5.2 episodes per 100,000 population, respectively: Figure 7).

Figure 7. Annual rate [note 10] of acquired CPO episodes per 100,000 population by index of multiple deprivation decile and sex [note 11] (England): April 2023 to March 2024

Notes to Figure 7

Note 10. Rates have been calculated using cumulative reports across the last four quarters of reporting, and as such cannot be compared to previous quarters (3).

Note 11. Information about patient sex is only recorded in 99.4% of cases.

Figure 8 shows the acquired CPO incidence annual rates by IMD decile and carbapenemase family between April 2023 to March 2024. The three carbapenemase families with the highest annual rates across all IMD deciles are OXA-48-like, KPC and NDM, where the annual rate generally declines with increasing IMD decile (least deprived); for example, the annual rate for OXA-48-like is 5.5 per 100,000 for the most deprived IMD decile and declines to 2.0 per 100,000 for the least deprived IMD decile.

Figure 8. Annual rate [note 10] of acquired CPO episodes per 100,000 population by index of multiple deprivation decile and resistance mechanism (England): April 2023 to March 2024

Notes to Figure 8

Note 6. Other carbapenemase families include DIM, GES, GIM, IMI and OXA-23 (in genera other than Acinetobacter spp.).

Note 10. Rates have been calculated using cumulative reports across the last four quarters of reporting, and as such cannot be compared to previous quarters (3).

Quarterly mandatory laboratory return reporting (April 2023 to March 2024)

Table 5. Quarterly mandatory laboratory returns (QMLR) for the total number of rectal swabs and faecal screening specimens taken for CPO screening by acute trust type [note 13] (England): April 2023 to March 2024

Trust type [note 13]	Q2 2023 reported screens (%)	Q2 2023 total screens	Q3 2023 reported screens (%)	Q3 2023 total screens	Q4 2023 reported screens (%)	Q4 2023 total screens	Q1 2024 reported screens (%)	Q1 2024 total screens
Small (n=21)	14 (66.7)	5,209	14 (66.7)	6,779	14 (66.7)	5,875	14 (66.7)	5,593
Medium (n=21)	20 (95.2)	6,931	19 (90.5)	7,216	18 (85.7)	6,762	15 (71.4)	6,632
Large (n=24)	19 (79.2)	14,010	18 (75.0)	18,357	19 (79.2)	20,308	20 (83.3)	20,410
Multi-service (n=7)	7 (100.0)	3,079	7 (100.0)	6,291	4 (57.1)	6,654	5 (71.4)	7,016
Specialist (n=16)	12 (75.0)	5,027	12 (75.0)	4,380	12 (75.0)	4,539	12 (75.0)	5,756
Teaching (n=48)	39 (81.3)	94,203	39 (81.3)	101,227	36 (75.0)	73,190	35 (72.9)	85,556
Total (n=137)	111 (81.0)	128,459	109 (79.6)	144,250	103 (75.2)	117,328	101 (73.7)	130,963

View this table in the data tables file.

Notes to Table 6

Note 13. Trust type obtained through NHS Digital Estate Return Information Collection (ERIC).

Reporting of quarterly totals of rectal swabs and faecal specimens taken for CPO screening was added to the mandatory quarterly laboratory returns (QMLR) section of the HCAI DCS in October 2019, and reporting became mandatory in October 2020. Between April 2023 and March 2024, there were 521,000 screens reported by 113 NHS Trusts, representing an overall Trust reporting rate of 82.5% (Table 5).  Of the acute Trusts that reported at least 1 screening report between April 2023 to March 2024, 4.4% reported that they conducted zero screens in Q1 2024 and 21.2% did not submit a return.

The number of Trusts that reported screens declined from 75.2% in Q4 2023 to 73.7% in Q1 2024. Acute teaching Trusts reported the majority of screens, accounting for 68.0% of screening swabs taken between April 2023 and March 2024. By reporting acute Trust, the total screens reported for the past four quarters ranged from 0 to 19,874. The full list of reporting, including those that did not submit a return, is available in the data tables by individual NHS acute Trust.

References

1. Department of Health and Social Care (2020). The Health Protection (Notification) (Amendment) (No.2) Regulations 2020/674

2. UKHSA (2023). Quarterly laboratory surveillance of acquired carbapenemase-producing Gram-negative bacteria in England: October 2020 to September 2022)

3. UKHSA (2024). Carbapenemase-producing Gram-negative organisms in England since October 2020: quarterly update, Q4 2023

Acknowledgements

These reports would not be possible without the weekly contributions from microbiology colleagues in laboratories across England. The support from colleagues within UKHSA, and the AMRHAI Reference Unit in particular, is valued in the preparation of the report. Feedback and specific queries about this report are welcome via hcai.amrdepartment@ukhsa.gov.uk