Research and analysis

Carbapenemase-producing Gram-negative organisms in England since October 2020: quarterly update, Q3 2024

Updated 23 December 2024

Applies to England

Main messages

Main messages from this report are as follows:

• Between October 2020 and September 2024, there were 18,743 acquired carbapenemase-producing organism (CPO) episodes reported to UKHSA; the majority were identified in screening samples, accounting for 71.8% of notifications, with only 822 (4.4%) reported from sterile site specimens.
• The quarterly rate of reported CPO episodes in Q3 2024 was the highest since mandatory reporting began in Q4 2020, with 3.8 per 100,000 population (n=2,116); this represents an increase from 3.5 per 100,000 population in (n=1,956) in Q2 2024, driven predominantly by an increase in positive screening samples.
• Reporting of CPO from sterile site specimens increased between Q2 2024 and Q3 2024, with the latest three quarters seeing the highest numbers of positive sterile site specimens since mandatory surveillance began.
• The most commonly reported acquired carbapenemase in the last year (Q4 2023 to Q3 2024) was NDM (35.6%), followed by OXA-48-like (34.7%) and KPC (20.6%); however, this varied by region. In London and the South East, NDM was the most commonly reported mechanism, OXA-48-like was most common in the East of England, whereas KPC continued to dominate reports in the North West.
• No changes were reported in the demographic groups (by age and sex, ethnic group and index of multiple deprivation (IMD) decile) since the last report.
• The commonly identified CPO mechanism reported switched in the West Midlands (OXA-48-like to KPC), and in Yorkshire and the Humber (KPC to NDM), between Q4 2023 and Q3 2024.

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 (CPOs).

The analyses below are based on data relating to notifications of confirmed acquired CPOs between 1 October 2020 and 30 September 2024 in England. The data was extracted on 19 November 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 included 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 (eg blood or cerebrospinal fluid), screening site specimens (eg faeces or lower gastrointestinal tract) or ‘other’ specimen type (eg 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 bacterial species, 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 isolates referred to the AMRHAI Reference Unit 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. (It should be noted that 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. Bacterial species, mechanism, sample type, 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 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 seek 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 among bacterial pathogens of carbapenemase genes covered by AMRHAI Reference Unit’s 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	<50E	0
GIM	<10D	<10D	0
SIM	0	<10D	0
SPM	0	<10D	0
OXA-23-like	<50E	0	¥
OXA-40-like	0	0	¥
OXA-51-likeA	0	0	¥
OXA-58-like	0	0	¥

Notes to Table 1

Note 1. Table 1 uses the following symbols:

¥ = combinations of mechanism and genus are not considered exceptional.

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.

E = fewer than 50 in total ever referred to AMRHAI Reference Unit.

Recent developments

Unusual acquired CPOs referred to the AMRHAI Reference Unit in Q3 2024 included three isolates of Pseudomonas aeruginosa positive for DIM metallo-carbapenemase. These were from two patients in the South West and Yorkshire and the Humber and were isolated from ear swabs; only 13 DIM-positive Pseudomonas spp. isolates from nine patients have been referred to the AMRHAI Reference Unit since 2015. One OXA-23-positive Proteus mirabilis was referred from the East Midlands from a urine culture. As neither OXA-23 nor DIM carbapenemase genes can be detected using diagnostic assays that target the ‘big 4/5’ carbapenemase families (‘big 5’ includes IMP), laboratories are reminded to refer isolates that meet AMRHAI referral criteria (2) to the Reference Unit for screening for rarer carbapenemase genes.

One Achromobacter xylosoxidans was also identified as VIM-positive. Laboratories that identify unusual hosts of the ‘big 4/5’ carbapenemase families such as this are requested to confirm local laboratory results by repeat testing from a single colony to confirm carbapenemase positivity and bacterial identification before referring to AMRHAI for inclusion in the national strain collection.The most common dual carbapenemase combination observed amongst Reference Unit referrals was NDM + OXA-48-like. However, in Q3 2024 the following combinations were also identified: one each of IMP + KPC, IMP + OXA-48-like,  KPC + OXA-48-like and VIM + NDM (the first three combinations all in Enterobacter cloacae complex isolates; the fourth in an Acinetobacter sp.), two VIM + OXA-48-like (both Enterobacter cloacae complex) and five KPC + NDM (one each of P. aeruginosa and Citrobacter freundii; three Klebsiella pneumoniae). Two isolates harboured three carbapenemase genes: one Escherichia coli was positive for IMP + NDM + OXA-48-like and one Klebsiella positive for KPC + OXA-48-like + NDM. Isolates with these combinations are currently rare amongst AMRHAI submissions and should be referred for confirmation (free-of-charge for NHS laboratories) and inclusion in the AMRHAI strain collection.

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 September 2024, there were 18,743 acquired CPO episodes reported. The majority were identified in screening samples, accounting for 71.8% of notifications, with only 822 (4.4%) reported from sterile site specimens (Table 2).

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

Specimen type	All reports number	All reports % [note 3]	From AMRHAI number	From AMRHAI % [note 4]
Sterile site samples	822	4.4	268	9.9
Screening samples	13,455	71.8	1,297	48.1
Other samples [note 2]	4,466	23.8	1,131	42.0
All samples	18,743	100.0	2,696	100.0

View this table in the data tables file.

Notes to Table 2

Note 2. Samples that did 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 12.9 per 100,000 population. In Q3 2024, the highest quarterly rate of CPO episodes was observed since mandatory reporting began in Q4 2020, with 3.8 episodes per 100,000 (Figure 1). This represents an 8.2% increase in rate since the previous quarter (3.5 CPO episodes per 100,000 in Q2 2024). This increase was predominantly due to an increase in positive screening samples, from 1,414 in Q2 2024 to 1,552 in Q3 2024. The number of sterile site infections increased by 17.1% in Q3 2024 compared with Q2 2024 (from 70 episodes in Q2 2024 to 82 episodes in Q3 2024) (Figure 1), with the number of reported sterile site infections more than doubling from Q4 2020 to Q3 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 16 quarters of notification data, it is too early to discern whether there may be any seasonality, particularly in light of the COVID-19 pandemic; quarterly changes may have been affected by the pandemic during this period, or may have been associated with local CPO outbreaks.

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

Epidemiology of CPO episodes over the last year (Q4 2023 to Q3 2024)

The data summaries in the rest of this report consider all sample types grouped together and only for the past rolling year (October 2023 to September 2024), using both annual and quarterly rates.

Geographical distribution

The annual rate of acquired CPO episodes varied by region (Office for National Statistics [ONS] regions) (Figure 2), with the highest overall rate between October 2023 and September 2024 reported in London (25.5 episodes per 100,000 population), followed by the North West region (23.0 episodes per 100,000 population). The lowest annual incidence across the last year was reported in the South West region (2.4 episodes per 100,000 population). Regional variation may be due to differences in incidence, variation in screening policies, outbreaks or reporting to national surveillance.

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

Notes to Figure 2

Note 5. The region geography is based on the patient’s residential postcode (if unknown, the 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 are shown in Table 3. The quarterly rate of reported CPO episodes in ONS regions increased between Q2 2024 and Q3 2024 in most regions. The largest increases in rate from Q2 2024 to Q3 2024 were seen in the South East (1.3 to 1.7 per 100,000 population), West Midlands (4.5 to 5.9 per 100,000 population), and North West (5.6 to 6.9 per 100,000 population). In the East Midlands, the rates decreased from 1.7 in Q2 2024 to 1.2 per 100,000 in Q3 2024.

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

ONS region	Q4 2023 number	Q4 2023 rate	Q1 2024 number	Q1 2024 rate	Q2 2024 number	Q2 2024 rate	Q3 2024 number	Q3 2024 rate
East Midlands	79	1.6	65	1.3	84	1.7	59	1.2
East of England	71	1.1	74	1.1	76	1.1	79	1.2
London	483	5.4	479	5.4	668	7.5	631	7.1
North East	92	3.4	77	2.9	190	7.1	183	6.8
North West	424	5.6	365	4.9	420	5.6	521	6.9
South East	140	1.5	110	1.2	117	1.3	153	1.7
South West	40	0.7	30	0.5	34	0.6	32	0.6
West Midlands	283	4.7	203	3.4	273	4.5	354	5.9
Yorkshire and The Humber	133	2.4	126	2.3	94	1.7	104	1.9

Geographical differences in carbapenemase family distribution

Between October 2023 and September 2024, the most common carbapenemase families reported across all regions were NDM (35.6%), OXA-48-like (34.7%), and KPC (20.6%), although the distribution of carbapenemase families identified varied regionally (Figure 3). 

In London, which had the highest annual incidence rate, the most reported carbapenemase families were NDM (48.0%) and OXA-48-like (37.8%). However, in the North West, which also had a high annual incidence rate, KPC accounted for 42.8% of episodes. KPC was not as common in any of the other regions, accounting for fewer than a third of episodes in each region; in London, KPC accounted for only 3.9% of episodes.

In the North East and Yorkshire and the Humber, IMP was more commonly reported compared to any of the other regions, accounting for 20.1% and 9.6% of episodes, respectively (other regions reporting ranged between 2.5% and 5.9% with the national average being 5.9%).

The distribution of carbapenemase families varied by quarter in some ONS regions (Data Table Appendix 1). For example, the most reported carbapenemase family in Yorkshire and the Humber was KPC in Q4 2023 (representing 41.4% of episodes, n=55), but switched to NDM in Q3 2024, accounting for 36.5% of episodes (n=38), followed by OXA-48-like (33.7%, n=35). A similar switch occurred in the West Midlands, where OXA-48-like was the most common CPO mechanism in Q4 2023 (57.6%, n=163) followed by KPC (23.0%, n=65). In Q3 2024, KPC now accounts for 38.1% (n=135) of CPO mechanisms, followed by OXA-48-like (37.0%, n=131). The number of KPC episodes doubled during this period (n=65 to 135). 

The East of England saw a recent increase in the proportion of CPOs with NDM, which represented 46.8% (n=37) of episodes in Q3 2024 compared with 33.8% (n=24) of episodes in Q4 2023 (Data Table Appendix 1). In Q3 2024 OXA-48-like was the most common (62.0%, n=44) and now accounts for 45.6% (n=36) of reported CPOs in the region. However, given the small number of CPO episodes reported in some regions, the diversity of carbapenemases reported in these regions is likely to be strongly impacted by individual outbreaks.

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

Notes to Figure 3

Note 6. Other carbapenemase families included DIM, GES, GIM, IMI, SME (in Enterobacterales).

Distribution of species and carbapenemase family

Between October 2023 to September 2024, the most frequently isolated Gram-negative bacterial species with an acquired carbapenemase was Escherichia coli, accounting for 34.0% of all CPOs. closely followed by Klebsiella pneumoniae (32.0%) (Table 4).

The carbapenemase family most frequently identified in E. coli and K. pneumoniae isolates was OXA-48-like (45.5% and 34.2%, respectively), followed by NDM (41.0% and 30.5%, respectively) and KPC (10.2% and 29.3%, respectively). In Enterobacter spp. isolates the most common carbapenemase family was NDM (36.5%), followed by KPC and OXA-48-like (23.0% and 21.3%, 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 that test 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 September 2024, DIM, GES, GIM, IMI, OXA-23 (in Enterobacterales) and SME carbapenemases were identified in small numbers of isolates and represented less than 2.9% of all reports.

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

Species	IMP number (%)	KPC number (%)	NDM number (%)	OXA-48-like number (%)	VIM number (%)	Other number (%)	Total no.	% of total per species
Escherichia coli	64 (2.6)	256 (10.2)	1,023 (41.0)	1,137 (45.5)	17 (0.7)	1 (0.0)	2,498	34.0
Klebsiella pneumoniae	89 (3.8)	689 (29.3)	717 (30.5)	803 (34.2)	52 (2.2)	0 (0.0)	2,350	32.0
Enterobacter spp.	211 (15.5)	313 (23.0)	496 (36.5)	289 (21.3)	38 (2.8)	12 (0.9)	1,359	18.5
Citrobacter spp.	35 (10.8)	61 (18.8)	90 (27.8)	120 (37.0)	18 (5.6)	0 (0.0)	324	4.4
Klebsiella oxytoca	6 (2.5)	132 (55.9)	12 (5.1)	77 (32.6)	9 (3.8)	0 (0.0)	236	3.2
Pseudomonas aeruginosa [note 7]	14 (8.9)	4 (2.5)	73 (46.5)	10 (6.4)	47 (29.9)	9 (5.7)	157	2.1
Other Enterobacterales [note 8]	7 (4.5)	27 (17.3)	89 (57.1)	32 (20.5)	1 (0.6)	0 (0.0)	156	2.1
Other Klebsiella spp.	3 (3.1)	23 (23.7)	20 (20.6)	47 (48.5)	4 (4.1)	0 (0.0)	97	1.3
Acinetobacter spp. [note 7]	3 (3.8)	1 (1.3)	70 (88.6)	4 (5.1)	1 (1.3)	0 (0.0)	79	1.1
Serratia spp.	2 (6.3)	3 (9.4)	12 (37.5)	15 (46.9)	0 (0.0)	0 (0.0)	32	0.4
Other Escherichia spp.	2 (11.1)	6 (33.3)	4 (22.2)	4 (22.2)	2 (11.1)	0 (0.0)	18	0.2
Morganella spp.	0 (0.0)	0 (0.0)	1 (9.1)	9 (81.8)	1 (9.1)	0 (0.0)	11	0.2
Other Gram-negative bacteria [note 9]	0 (0.0)	0 (0.0)	2 (28.6)	3 (42.9)	2 (28.6)	0 (0.0)	7	0.1
Total	436 (5.9)	1,515 (20.6)	2,612 (35.6)	2,550 (34.7)	211 (2.9)	22 (0.3)	7,346	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 KPC and OXA-48-like in Acinetobacter spp. are extremely rare, and positive results should be interpreted with caution.

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 isolates reported here have not all been confirmed by the AMRHAI Reference Unit and laboratories identifying these unusual combinations should refer such isolates to AMRHAI.

Distribution of demographic risk factors

Between October 2023 and September 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 14.1 and 11.6 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 October 2023 and September 2024, with the highest annual rate reported in those 85 years and over (4.3 per 100,000 population) followed by those aged 75 to 84 years (5.5 per 100,000 population). For infants less than 1 year old, the CPO annual incidence rate was 8.2 per 100,000 population

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

Notes to Figure 4

Note 10. Information about patient sex is recorded in 99.5% of cases.

Figure 5 shows the reported acquired CPO annual incidence rates by ethnic group and sex between October 2023 and September 2024, with the highest annual rate reported in those of Asian or Asian British ethnicity (21.0 per 100,000 population), followed by those of Black, Black British, Caribbean or African ethnicity (14.5 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 12.1 and 10.4 episodes per 100,000 population, respectively: Figure 5).

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

Notes to Figure 5

Note 10. Information about patient sex is recorded in 99.5% of cases.

Note 11. Information about patient ethnicity is recorded in 86.5% of cases.

The most common carbapenemase families identified in individuals of Asian or Asian British ethnicity were NDM (n=630, 55.4%) and OXA-48-like (n=392, 34.5%) (Figure 6). KPC was not as common in patients of Asian or Asian British ethnicity (n=60, 5.3%) as it was in those of White ethnicity, where KPC accounted for 27.2% of episodes (n=1,294).

Figure 6. Distribution of acquired carbapenemase families by ethnic group [note 11] and carbapenemase family (England): October 2023 to September 2024

Notes to Figure 6

Note 6. Other carbapenemase families included DIM, GES, GIM, IMI and SME.

Note 11. Information about patient ethnicity in recorded in 86.5% of cases.

Figure 7 shows the acquired CPO annual incidence rates by IMD decile and sex between October 2023 and September 2024. The highest annual rate was reported in those in the most deprived decile (19.0 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 (7.8 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 14.0 and 11.7 episodes per 100,000 population, respectively: Figure 7). Additionally, the distribution of CPO infections by IMD decile was noted across the wider population in England where, in 2023, the rate of resistant bacteraemia was higher in the most deprived quintile (38.1 per 100,000 population) compared to the least deprived quintile (36.7 per 10,000 population) compared to the least deprived quintile (26.7 per 100,000) (3).

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

Notes to Figure 7

Note 10. Information about patient sex is recorded in 99.5% of cases.

Figure 8 shows the acquired CPO incidence annual rates by IMD decile and carbapenemase family between October 2023 to September 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).

Figure 8. Annual rate of acquired CPO episodes per 100,000 population by index of multiple deprivation decile and resistance mechanism (England): October 2023 to September 2024

Notes to Figure 8

Note 6. Other carbapenemase families include DIM, GES, GIM, IMI and SME.

Quarterly mandatory laboratory return reporting (October 2023 to September 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 12] (England): October 2023 to September 2024

Trust type [note 12]	Q4 2023 reported screens (%)	Q4 2023 total screens	Q1 2024 reported screens (%)	Q1 2024 total screens	Q2 2024 reported screens (%)	Q2 2024 total screens	Q3 2024 reported screens (%)	Q3 2024 total screens
Small (n=19)	15 (78.9)	6,221	15 (78.9)	5,961	14 (73.7)	7,268	12 (63.2)	7,443
Medium (n=21)	19 (90.5)	7,079	20 (95.2)	7,956	20 (95.2)	10,953	15 (71.4)	10,725
Large (n=24)	20 (83.3)	20,444	20 (83.3)	20,410	21 (87.5)	20,946	19 (79.2)	21,664
Multi-service (n=7)	6 (85.7)	8,283	6 (85.7)	8,756	6 (85.7)	10,818	3 (42.9)	6,809
Specialist (n=16)	12 (75.0)	5,067	12 (75.0)	5,127	12 (75.0)	6,457	12 (75.0)	7,783
Teaching (n=48)	40 (83.3)	96,633	41 (85.4)	118,117	40 (83.3)	120,702	35 (72.9)	94,633
Total (n=135)	112 (83.0)	143,787	114 (84.4)	167,657	113 (83.7)	178,470	98 (72.6)	155,155

View this table in the data tables file.

Notes to Table 5

Note 12. 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. In Q3 2024, there were 155,155 screens reported by 99 NHS Trusts, representing an overall Trust reporting rate of 72.8% (Table 5). As of the writing of this report, 18 (15.3%) Trusts had not reported any screens and 3 (5%) Trusts reported zero screens between Q4 2023 and Q3 2024. The lower report rate for Q3 2024 may be due to late reports as the report rate for Q2 2024 has changed since the previous report (4).

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). Bacteriology Reference Department User Manual

3. UKHSA (2024). English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report 2023 to 2024

4. UKHSA (2024). Carbapenemase-producing Gram-negative organisms in England since October 2020: quarterly update, Q2 2024

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