Research and analysis

Carbapenemase-producing Gram-negative organisms in England since October 2020: quarterly update, Q4 2023

Updated 13 May 2024

Applies to England

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 30 December 2023 in England. The data was extracted on 6 March 2024 from both UKHSA’s voluntary surveillance database, SGSS, and the Antimicrobial Resistance and Healthcare-Associated Infections (AMRHAI) Reference Unit database.

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 patient’s GP was used. Failing that, 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.

As patients may have more than one positive specimen taken, specimens taken from the same patient that yielded growth of the same pathogen, carbapenemase and specimen type within a 52-week period from the initial positive specimen were regarded as comprising the same episode and were de-duplicated. 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). 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. (It should be noted that not all specimens in this report are confirmed by AMRHAI.) This method differs slightly from that of the 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 species 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 species 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 Q4 2023 consisted of one isolate of Aeromonas caviae positive for a blaOXA-48-like gene from an environmental sample in the North West. Carbapenem resistance in Aeromonas spp. is usually mediated by a chromosomal cphA gene, which confers a metallo-carbapenemase-like phenotype, but occasionally transmissible carbapenemase genes belonging to the ‘big 5’ families have been identified (2). The AMRHAI Reference Unit does not currently seek carbapenem-resistant Aeromonas spp. unless there is reason to suspect they are carrying an acquired carbapenemase gene. A rectal swab isolate of Klebsiella pneumoniae ST258 producing a KPC enzyme with the D179Y amino acid substitution that confers resistance to ceftazidime/avibactam (3) was referred by a London laboratory; this is only the second such isolate that AMRHAI have identified amongst submissions since PCR screening was introduced in 2019. A further two Proteus mirabilis isolates carrying a blaOXA-23 carbapenemase gene were referred by laboratories in the South East and London from a urine sample and a rectal swab; sequencing analysis is being undertaken to compare these with the previous isolates referred to AMRHAI and with the OXA-23-producing P. mirabilis clone reported in France and Belgium.

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 isolates have been due to mixed cultures or reporting errors.

Specimen type

Between October 2020 and December 2023, there were 13,126 acquired CPO episodes reported. The majority were identified in screening samples, accounting for 71.9% of notifications, with only 4.5% reported in sterile site specimens (Table 2).

Table 2. Number and percentage of acquired CPO episodes by specimen type (England): October 2020 to December 2023

Specimen type	All reports number	All reports % [note 3]	From AMRHAI number	From AMRHAI % [note 4]
Sterile site samples	597	4.5	215	10.8
Screening samples	9,432	71.9	940	47.2
Other samples [note 2]	3,097	23.6	838	42.0
All samples	13,126	100.0	1,993	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 quarterly rate of acquired CPO episodes between October 2020 and December 2023 is shown in Figure 1.

Although in this quarter the rate of CPO episodes continues to increase, from 2.8 per 100,000 population in Q3 2023 to 3.1 per 100,000 population in Q4 2023, this rise was predominantly due to increases in rates among ‘other’ sample types, and a small increase in the rate sterile site isolates (Figure 1). The rate of CPO episodes from screening isolates remained stable in Q4 compared to Q3 of 2023; however this rate represents a higher rate of episodes compared to quarters prior to Q3 2023.

It is important to note that quarterly changes in rate of episodes may reflect an uptick in screening following changes to screening policy and/or an improvement in national reporting of CPO episodes rather than an actual increase in incidence. Furthermore, as there are only 13 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.

The remaining data summaries in this report consider all samples grouped together, except Table 4.

Figure 1. Rate of acquired CPO episodes by specimen type and quarter (England): October 2020 to December 2023

Geographic distribution

The rate of acquired CPO episodes varied by Office for National Statistics (ONS) region (Figure 2), with the highest overall rate between January 2023 and December 2023 reported in London (2.4 episodes per 100,000 population), followed by the North West (2.2 episodes per 100,000 population). The lowest incidence across the last year was reported in the South West region (0.2 per 100,000 population).

Figure 2. Geographical distribution of acquired CPO incidence rates per 100,000 population (England): January 2023 to December 2023 [note 5]

Notes to Figure 2

Note 5. The region geography is based on the laboratory location and linked to the ONS data for regions.

The number and rate of reported acquired CPO episodes for each ONS region by calendar quarter is shown in Table 3.

The rate of bacterial episodes in all ONS regions increased from Q3 2023 to Q4 2023 in all regions except London and the North East, where the rates decreased (but still remained above the reported rates in Q1 and Q2). The rate in the South East nearly doubled (0.8 to 1.5 per 100,000 population) and the the rate for Yorkshire and Humber increased by a third (1.7 to 2.4 per 100,000 population).

Table 3. Number of acquired CPO episodes and rate per 100,000 population by ONS region (England): January 2023 to December 2023

ONS region	Q1 number	Q1 rate	Q2 number	Q2 rate	Q3 number	Q3 rate	Q4 number	Q4 rate
East Midlands	48	1.0	46	0.9	51	1.0	69	1.4
East of England	25	0.4	33	0.5	55	0.9	71	1.1
London	438	5.0	450	5.1	522	5.9	478	5.4
North East	57	2.2	38	1.4	101	3.8	92	3.5
North West	310	4.2	349	4.7	404	5.4	422	5.7
South East	63	0.7	71	0.8	75	0.8	138	1.5
South West	16	0.3	17	0.3	34	0.6	37	0.6
West Midlands	132	2.2	200	3.4	253	4.3	284	4.8
Yorkshire and The Humber	74	1.4	74	1.4	93	1.7	133	2.4

View this table in the data tables file

The number of acquired CPO episodes for each ONS region by calendar quarter and specimen type is shown in Table 4.

London had the highest percentage of bacterial episodes reported in sterile site specimens and screening samples across all four quarters (Q1 2023 – Q4 2023) compared to other regions, whereas the North West had the highest percentage of bacterial episodes reported in other samples, replacing London, for Q4 2023. An increase from 5.0% in Q3 2023 to 17.3% in Q4 2023 in sterile site specimens was noted in the South East, comprising an additional 10 sterile site samples reported in Q4 compared to Q3 (Table 4) – this increase is being investigated further.

Table 4. Percentage of acquired CPO episodes by ONS region and specimen type (England): January 2023 to December 2023

	ONS region	Q1 Sterile site %	Q2 Sterile site %	Q3 Sterile site %	Q4 Sterile site %	Q1 Screening %	Q2 Screening %	Q3 Screening %	Q4 Screening %	Q1 Other % [note 1]	Q2 Other % [note 1]	Q3 Other % [note 1]	Q4 Other % [note 1]
	East Midlands	5.1	3.1	5.0	6.7	4.4	3.0	2.9	3.9	3.3	5.6	4.0	3.9
	East of England	1.7	4.7	10.0	16.0	1.0	1.0	1.3	2.0	5.3	6.9	10.4	7.6
	London	44.1	45.3	53.3	34.7	37.3	33.5	33.0	26.7	37.4	38.3	28.7	29.3
	North East	6.8	1.6	3.3	0.0	4.6	3.3	7.1	7.0	5.3	2.3	4.3	2.0
	North West	18.6	15.6	3.3	9.3	31.5	32.3	29.8	23.3	15.2	14.9	13.4	29.9
	South East	6.8	3.1	5.0	17.3	4.4	4.1	3.4	7.0	7.9	10.6	9.5	9.1
	South West	3.4	3.1	1.7	1.3	0.7	1.2	1.8	2.2	2.6	1.3	3.4	2.2
	West Midlands	10.2	9.4	10.0	10.7	10.2	16.6	15.7	19.8	14.6	14.2	18.0	8.9
	Yorkshire and The Humber	3.4	14.1	8.3	4.0	5.9	5.2	5.0	8.2	8.3	5.9	8.5	7.2

Notes to Table 4

Note 1. Samples that do not fall into either ‘sterile site’ or ‘screening’ samples, for example, urine and lower genital tract specimens.

Geographical differences in carbapenemase family

Between January 2023 and December 2023, the most common carbapenemase families reported across all regions were NDM (34.8%), OXA-48-like (34.1%) and KPC (22.8%). However, the distribution of carbapenemase families identified varied regionally (Figure 3).

In London, which had the highest incidence rate, the most commonly reported carbapenemase families identified were NDM (47.0%) and OXA-48-like (38.4%). However, in the North West, which also had a high incidence rate, KPC accounted for 49.2% of episodes. KPC was not as common in any of the other regions, accounting for fewer than 31.9% of episodes in each region; in London, KPC accounted for 4.3% of episodes.

Another regional difference was observed in the North East and Yorkshire and the Humber, where IMP was more commonly reported compared to any of the other regions, accounting for 16.0% and 11.0% of episodes, respectively (other regions reporting fewer than 8.6%). 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 incidence rates, the most common carbapenemase family was OXA-48-like (60.3% in the East of England and 45.2% 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 West Midlands was predominantly OXA-48-like in Q4 2023 (57.4%) but in Q1 2023 it was predominantly KPC (37.1%).

Figure 3. Geographical distribution of acquired CPO episodes by carbapenemase family (England): January 2023 to December 2023

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 January 2023 and December 2023, the most frequently isolated Gram-negative bacterial species with a confirmed acquired CPO was Escherichia coli, accounting for 33.3% of all specimens. This was followed by Klebsiella pneumoniae, and Enterobacter spp., which accounted for 31.2% and 18.8% of all specimens, respectively (Table 5).

The carbapenemase family most frequently identified in E. coli and K. pneumoniae isolates was OXA-48-like (41.8% and 35.3%, respectively). In Enterobacter spp. isolates this was NDM (39.5%),  followed by KPC and OXA-48-like carbapenemase families (22.9% and 20.6%, respectively). In E. coli the mechanisms most commonly reported after OXA-48-like were NDM and KPC (41.7% and 13.8%, respectively), and in K. pneumoniae isolates KPC and NDM carbapenemase families (30.4% and 29.3%, 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 are negative for the ‘big 5’ carbapenemase families are referred to the AMRHAI Reference Unit for further testing. Between October 2020 and December 2023, DIM, GES, GIM, IMI, OXA-23 and SME carbapenemases were identified in small numbers (1, 29, 8, 34, 8 and 2, respectively), with only five isolates (GIM positive) being identified from invasive specimens.

Table 5. Acquired CPO episodes by species and carbapenemase family (England): January 2023 to December 2023

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]	6  (10.7)	1  (1.8)	45 (80.4)	2  (3.6)	2  (3.6)	0  (0.0)	56	1.0
Citrobacter spp.	13  (4.4)	72 (24.3)	64 (21.6)	133 (44.9)	13  (4.4)	1  (0.3)	296	5.1
Enterobacter spp.	144 (13.3)	247 (22.9)	426 (39.5)	222 (20.6)	31  (2.9)	9  (0.8)	1,079	18.8
Escherichia coli	35  (1.8)	265 (13.8)	799 (41.7)	800 (41.8)	16  (0.8)	0  (0.0)	1,915	33.3
Other Escherichia spp.	2 (13.3)	10 (66.7)	2  (13.3)	1  (6.7)	0 (0.0)	0  (0.0)	15	0.3
Klebsiella oxytoca	4  (2.1)	102 (54.0)	17  (9.0)	61 (32.3)	5  (2.6)	0  (0.0)	189	3.3
Klebsiella pneumoniae	41  (2.3)	547 (30.4)	527 (29.3)	635 (35.3)	46  (2.6)	1  (0.1)	1,797	31.2
Other Klebsiella spp.	4  (5.0)	20 (25.0)	17 (21.3)	37 (46.3)	2  (2.5)	0  (0.0)	80	1.4
Morganella spp.	0  (0.0)	1  (6.3)	4  (25.0)	9 (56.3)	2  (12.5)	0  (0.0)	16	0.3
Pseudomonas aeruginosa [note 7]	19 (13.9)	3  (2.2)	53 (38.7)	6  (4.4)	48 (35.0)	8  (5.8)	137	2.4
Other Pseudomonas spp. [note 7]	0  (0.0)	1  (3.7)	9  (33.3)	0  (0.0)	17 (63.0)	0  (0.0)	27	0.5
Serratia spp.	0  (0.0)	0  (0.0)	9  (33.3)	18 (66.7)	0  (0.0)	0  (0.0)	27	0.5
Other Enterobacterales [note 8]	4  (3.4)	42 (36.2)	31 (26.7)	37 (31.9)	2  (1.7)	0  (0.0)	116	2.0
Other Gram-negative bacteria [note 9]	1  (50.0)	0  (0.0)	1  (50.0)	0  (0.0)	0  (0.0)	0  (0.0)	2	0.0
Total	273 (4.7)	1311 (22.8)	2004 (34.8)	1961 (34.1)	184 (3.2)	19  (0.3)	5,752	100.0

View this table in the data tables file

Notes to Table 5

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 January 2023 to December 2023, the 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 rate was higher in males compared to females (overall rates of 9.9 and 7.4 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 incidence rates by age group between January 2023 to December 2023, with the highest rate reported in those 85 years and over (91.6 per 100,000 population) followed by those aged 75-84 years (33.0 per 100,000 population). The overall rate of confirmed CPOs was 11.2 per 100,000 population in infants less than one year old.

Figure 4. Rate [note 10] of acquired CPO episodes per 100,000 population by age and sex [note 11] (England): January 2023 to December 2023

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 (4).

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

Figure 5. Rate [note 10] of acquired CPO episodes per 100,000 population by sex [note 11] and ethnic group [note 12] (England): January 2023 to December 2023

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 (4).

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

Note 12. Information about patient ethnicity in only recorded in 89.5% of cases.

Between January 2023 and December 2023, the most common carbapenemase families reported across all ethnic groups were OXA-48-like (34.6%), NDM (32.5%), and KPC (24.6%)  (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 incidence rate, the most common carbapenemase families identified were NDM (56.9%) and OXA-48-like (32.9%). KPC was not as common in those of Asian or Asian British ethnicity (7.3%) however in those of White ethnicity, KPC accounted for 30.0% of episodes.

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

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 89.5% of cases.

Figure 7 shows the acquired CPO incidence rates by IMD decile and sex between January 2023 to December 2023. The highest rate was reported in those in the bottom two (most deprived) deciles (both 14.5 per 100,000 population). The rate generally declines as the IMD decile increases, with the lowest 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 rate was higher in males compared to females (overall rates of 7.1 and 4.9 episodes per 100,000 population, respectively).

Figure 7. Rate [note 10] of acquired CPO episodes per 100,000 population by index of multiple deprivation decile and sex [note 11] (England): January 2023 to December 2023

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 (4).

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

Figure 8 shows the acquired CPO incidence rates by IMD decile and carbapenemase family between January 2023 to December 2023. The three carbapenemase families with the highest rates across all IMD deciles are OXA-48-like, KPC and NDM, where the rate generally declines with increasing IMD decile (least deprived); for example, the rate for OXA-48-like is 4.4 per 100,000 for the most deprived IMD decile and declines to 1.8 per 100,000 for the least deprived IMD decile.

Figure 8. Rate [note 10] of acquired CPO episodes per 100,000 population by index of multiple deprivation decile and resistance mechanism (England): January 2023 to December 2023

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 (4).

Quarterly mandatory laboratory return reporting (January 2023 to December 2023)

Table 6. 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): January 2023 to December 2023

Trust type [note 13]	Q1 2023 reported screens (%)	Q1 2023 total screens	Q2 2023 reported screens (%)	Q2 2023 total screens	Q3 2023 reported screens (%)	Q3 2023 total screens	Q4 2023 reported screens (%)	Q4 2023 total screens
Small (n=21)	13  (61.9)	5,783	14  (66.7)	5,209	13  (61.9)	6,542	12  (57.1)	5,421
Medium (n=21)	19  (90.5)	7,051	18  (85.7)	6,741	17  (81.0)	7,017	14  (66.7)	5,293
Large (n=24)	19  (79.2)	11,980	19  (79.2)	14,010	18  (75.0)	18,357	18  (75.0)	20,046
Multi-service (n=7)	7  (100.0)	2,219	7  (100.0)	3,079	7  (100.0)	6,291	4  (57.1)	6,654
Specialist (n=16)	11  (68.8)	4,196	11  (68.8)	4,441	11  (68.8)	4,073	11  (68.8)	4,225
Teaching (n=48)	38  (79.2)	70,714	36  (75.0)	72,829	37  (77.1)	78,715	32  (66.7)	58,550
Total (n=137)	107 (78.1)	101,943	105 (76.6)	106,309	103 (75.2)	120,995	91  (66.4)	100,189

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 January 2023 to December 2023, there were 429,436 screens reported by 108 NHS Trusts leading to an overall Trust reporting rate of 78.8% (Table 5).  Of the acute Trusts that reported at least 1 screening report between January 2023 to December 2023, 4.6% reported that they conducted zero screens and 26.9% did not submit a return.

Between January 2023 to December 2023, the number of Trusts that reported screens declined from 78.1% to 66.4%. Reported screening was more predominant in the acute teaching Trusts, accounting for 65.4% of screening swabs taken during this time period. By reporting acute Trust, the total screens reported for the past four quarters ranged from 0 to 19,078. The full list of reporting, including those that did not submit a return, is available in the data appendix 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. Drk, S., Puljko, A., Dželalija, M., & Udiković-Kolić, N. (2023). Characterization of Third Generation Cephalosporin- and Carbapenem-Resistant Aeromonas Isolates from Municipal and Hospital Wastewater. Antibiotics: volume 12, number 3, page 513

3. Shields R K, Chen L, Cheng S, Chavda KD, Press E G, Snyder A, and others (2017). Emergence of Ceftazidime-Avibactam Resistance Due to Plasmid-Borne blaKPC-3 Mutations during Treatment of Carbapenem-Resistant Klebsiella pneumoniae Infections. Antimicrobial agents and chemotherapy, volume 61, number 3

4. UKHSA (2023). Quarterly laboratory surveillance of acquired CPO in England: October 2020 to December 2022

Appendix

Appendix Table 1. QMLR returns for the total number of rectal swabs and faecal screening specimens taken for CPO screening by acute trust (England): January 2023 to December 2023

Trust name	Trust type	Q1 2023	Q2 2023	Q3 2023	Q4 2023
Airedale NHS Foundation Trust	Small	2,161	327	381	359
Alder Hey Children’s NHS Foundation Trust	Specialist	1,210	1,256	1,178	1,130
Ashford and St Peter’s Hospitals NHS Foundation Trust	Medium	257	228	223	256
Barking, Havering and Redbridge University Hospitals NHS Trust	Teaching	1,171	1,322	1,402	N/r
Barnsley Hospital NHS Foundation Trust	Small	43	228	229	392
Barts Health NHS Trust	Teaching	3,143	3,706	4,032	4,048
Bedfordshire Hospitals NHS Foundation Trust	Medium	109	112	115	131
Birmingham Women’s and Children’s NHS Foundation Trust	Specialist	N/r	N/r	N/r	N/r
Blackpool Teaching Hospitals NHS Foundation Trust	Teaching	753	853	844	874
Bolton NHS Foundation Trust	Medium	358	697	547	N/r
Bradford Teaching Hospitals NHS Foundation Trust	Teaching	2,161	2,403	2,355	2,304
Buckinghamshire Healthcare NHS Trust	Multi-service	315	473	549	606
Calderdale and Huddersfield NHS Foundation Trust	Large	272	482	517	609
Cambridge University Hospitals NHS Foundation Trust	Teaching	1,719	1,876	2,086	2,697
Chelsea and Westminster Hospital NHS Foundation Trust	Teaching	N/r	N/r	N/r	N/r
Chesterfield Royal Hospital NHS Foundation Trust	Small	N/r	N/r	N/r	N/r
Countess of Chester Hospital NHS Foundation Trust	Small	N/r	N/r	N/r	N/r
County Durham and Darlington NHS Foundation Trust	Multi-service	161	917	1,905	3,410
Croydon Health Services NHS Trust	Medium	493	119	199	210
Dartford and Gravesham NHS Trust	Small	263	230	263	237
Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust	Teaching	222	304	895	501
Dorset County Hospital NHS Foundation Trust	Small	92	184	181	264
East and North Hertfordshire NHS Trust	Large	1,144	1,252	1,439	1,437
East Cheshire NHS Trust	Small	N/r	N/r	N/r	N/r
East Kent Hospitals University NHS Foundation Trust	Teaching	328	462	526	499
East Lancashire Hospitals NHS Trust	Large	351	509	452	491
East Suffolk and North Essex NHS Foundation Trust	Large	N/r	N/r	N/r	N/r
East Sussex Healthcare NHS Trust	Large	299	238	256	216
Epsom and St Helier University Hospitals NHS Trust	Teaching	277	265	293	N/r
Frimley Health NHS Foundation Trust	Large	679	793	2,221	2,707
Gateshead Health NHS Foundation Trust	Medium	55	N/r	N/r	N/r
George Eliot Hospital NHS Trust	Small	N/r	213	224	274
Gloucestershire Hospitals NHS Foundation Trust	Large	129	131	214	204
Great Ormond Street Hospital For Children NHS Foundation Trust	Specialist	1,747	1,715	1,692	1,641
Great Western Hospitals NHS Foundation Trust	Medium	147	186	198	230
Guy’s and St Thomas’ NHS Foundation Trust	Teaching	2,599	2,726	3,198	N/r
Hampshire Hospitals NHS Foundation Trust	Large	380	258	779	657
Harrogate and District NHS Foundation Trust	Small	109	101	100	143
Homerton Healthcare NHS Foundation Trust	Teaching	854	892	939	1,158
Hull University Teaching Hospitals NHS Trust	Teaching	211	219	1,002	789
Imperial College Healthcare NHS Trust	Teaching	18,424	17,909	19,078	N/r
Isle of Wight NHS Trust	Multi-service	35	44	53	N/r
James Paget University Hospitals NHS Foundation Trust	Teaching	N/r	N/r	N/r	N/r
Kettering General Hospital NHS Foundation Trust	Small	238	316	287	218
King’s College Hospital NHS Foundation Trust	Teaching	N/r	N/r	N/r	N/r
Kingston Hospital NHS Foundation Trust	Medium	100	257	216	335
Lancashire Teaching Hospitals NHS Foundation Trust	Teaching	596	826	822	852
Leeds Teaching Hospitals NHS Trust	Teaching	6,322	5,040	6,041	11,607
Lewisham and Greenwich NHS Trust	Large	829	785	1,540	2,593
Liverpool Heart and Chest Hospital NHS Foundation Trust	Specialist	N/r	N/r	N/r	N/r
Liverpool University Hospitals NHS Foundation Trust	Teaching	N/r	N/r	N/r	N/r
Liverpool Women’s NHS Foundation Trust	Specialist	N/r	N/r	N/r	N/r
London North West University Healthcare NHS Trust	Teaching	734	1,863	21	77
Maidstone and Tunbridge Wells NHS Trust	Large	293	311	346	309
Manchester University NHS Foundation Trust	Teaching	N/r	N/r	N/r	N/r
Medway NHS Foundation Trust	Medium	N/r	N/r	N/r	N/r
Mid and South Essex NHS Foundation Trust	Large	N/r	N/r	N/r	N/r
Mid Cheshire Hospitals NHS Foundation Trust	Small	N/r	N/r	N/r	N/r
Mid Yorkshire Hospitals NHS Trust	Large	N/r	N/r	N/r	N/r
Milton Keynes University Hospital NHS Foundation Trust	Teaching	N/r	N/r	N/r	N/r
Moorfields Eye Hospital NHS Foundation Trust	Specialist	0	0	0	0
Norfolk and Norwich University Hospitals NHS Foundation Trust	Teaching	524	523	446	479
North Bristol NHS Trust	Large	N/r	N/r	N/r	N/r
North Cumbria Integrated Care NHS Foundation Trust	Small	1,030	1,163	600	N/r
North Middlesex University Hospital NHS Trust	Teaching	N/r	N/r	N/r	N/r
North Tees and Hartlepool NHS Foundation Trust	Medium	284	290	N/r	N/r
North West Anglia NHS Foundation Trust	Large	151	207	216	104
Northampton General Hospital NHS Trust	Medium	829	662	665	N/r
Northern Care Alliance NHS Foundation Trust	Teaching	804	894	603	510
Northern Lincolnshire and Goole NHS Foundation Trust	Medium	52	184	368	273
Northumbria Healthcare NHS Foundation Trust	Large	185	225	235	264
Nottingham University Hospitals NHS Trust	Teaching	1,732	1,696	2,136	2,215
Oxford University Hospitals NHS Foundation Trust	Teaching	1,781	2,002	2,108	2,273
Portsmouth Hospitals University National Health Service Trust	Large	246	264	268	323
Queen Victoria Hospital NHS Foundation Trust	Specialist	0	6	0	3
Royal Berkshire NHS Foundation Trust	Large	1,497	2,514	2,474	2,404
Royal Cornwall Hospitals NHS Trust	Large	202	224	201	N/r
Royal Devon University Healthcare NHS Foundation Trust	Large	192	330	448	390
Royal Free London NHS Foundation Trust	Teaching	8,340	8,311	8,298	9,022
Royal National Orthopaedic Hospital NHS Trust	Specialist	189	201	203	220
Royal Papworth Hospital NHS Foundation Trust	Specialist	99	44	78	80
Royal Surrey County Hospital NHS Foundation Trust	Medium	1,209	1,249	1,356	1,309
Royal United Hospitals Bath NHS Foundation Trust	Medium	303	548	558	475
Salisbury NHS Foundation Trust	Small	144	188	N/r	N/r
Sandwell and West Birmingham Hospitals NHS Trust	Large	N/r	N/r	N/r	N/r
Sheffield Children’s NHS Foundation Trust	Specialist	111	86	57	69
Sheffield Teaching Hospitals NHS Foundation Trust	Teaching	1,127	1,138	1,499	1,487
Sherwood Forest Hospitals NHS Foundation Trust	Medium	N/r	N/r	N/r	N/r
Somerset NHS Foundation Trust	Multi-service	854	1,450	2,967	2,306
South Tees Hospitals NHS Foundation Trust	Teaching	288	466	501	449
South Tyneside and Sunderland NHS Foundation Trust	Large	N/r	N/r	N/r	N/r
South Warwickshire University NHS Foundation Trust	Medium	533	638	903	931
Southport and Ormskirk Hospital NHS Trust	Small	N/r	N/r	N/r	N/r
St George’s University Hospitals NHS Foundation Trust	Teaching	988	1,176	1,096	1,206
St Helens and Knowsley Teaching Hospitals NHS Trust	Teaching	1,274	1,634	1,612	9
Stockport NHS Foundation Trust	Medium	388	427	397	371
Surrey and Sussex Healthcare NHS Trust	Medium	252	265	233	285
Tameside and Glossop Integrated Care NHS Foundation Trust	Small	192	253	234	N/r
The Christie NHS Foundation Trust	Specialist	223	393	382	485
The Clatterbridge Cancer Centre NHS Foundation Trust	Specialist	N/r	N/r	N/r	N/r
The Dudley Group NHS Foundation Trust	Medium	40	39	30	54
The Hillingdon Hospitals NHS Foundation Trust	Small	N/r	N/r	N/r	N/r
The Newcastle Upon Tyne Hospitals NHS Foundation Trust	Teaching	670	1001	922	764
The Princess Alexandra Hospital NHS Trust	Small	232	254	204	207
The Queen Elizabeth Hospital, King’s Lynn, NHS Foundation Trust	Small	219	203	161	217
The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust	Specialist	104	126	42	46
The Rotherham NHS Foundation Trust	Small	16	26	0	2
The Royal Marsden NHS Foundation Trust	Specialist	128	202	112	209
The Royal Orthopaedic Hospital NHS Foundation Trust	Specialist	385	412	329	342
The Royal Wolverhampton NHS Trust	Large	2,219	2,525	2,777	2,970
The Shrewsbury and Telford Hospital NHS Trust	Medium	114	104	152	112
The Walton Centre NHS Foundation Trust	Specialist	N/r	N/r	N/r	N/r
Torbay and South Devon NHS Foundation Trust	Multi-service	1	8	12	N/r
United Lincolnshire Hospitals NHS Trust	Large	743	627	943	1193
University College London Hospitals NHS Foundation Trust	Teaching	957	950	977	1064
University Hospital Southampton NHS Foundation Trust	Teaching	647	1,290	771	804
University Hospitals Birmingham NHS Foundation Trust	Teaching	N/r	N/r	N/r	N/r
University Hospitals Bristol and Weston NHS Foundation Trust	Teaching	0	N/r	687	584
University Hospitals Coventry and Warwickshire NHS Trust	Teaching	1,146	N/r	1,433	1,287
University Hospitals Dorset NHS Foundation Trust	Teaching	170	224	178	232
University Hospitals of Derby and Burton NHS Foundation Trust	Teaching	222	227	222	216
University Hospitals of Leicester NHS Trust	Teaching	8,018	7,911	8,819	8,554
University Hospitals of Morecambe Bay NHS Foundation Trust	Teaching	204	232	N/r	N/r
University Hospitals of Morecambe Bay NHS Foundation Trust	Teaching	8,018	7,911	8,819	8,554
University Hospitals of North Midlands NHS Trust	Teaching	N/r	N/r	N/r	N/r
University Hospitals Plymouth NHS Trust	Teaching	919	888	997	N/r
University Hospitals Sussex NHS Foundation Trust	Teaching	526	483	487	549
Walsall Healthcare NHS Trust	Small	991	1,513	2,030	1,850
Warrington and Halton Teaching Hospitals NHS Foundation Trust	Teaching	272	388	376	394
West Hertfordshire Teaching Hospitals NHS Trust	Medium	836	0	957	1,046
West Suffolk NHS Foundation Trust	Small	N/r	N/r	N/r	N/r
Whittington Health NHS Trust	Multi-service	543	140	286	N/r
Wirral University Teaching Hospital NHS Foundation Trust	Teaching	N/r	N/r	N/r	N/r
Worcestershire Acute Hospitals NHS Trust	Large	2,074	2,199	3,031	3,054
Wrightington, Wigan and Leigh NHS Foundation Trust	Medium	195	211	203	206
Wye Valley NHS Trust	Multi-service	310	47	519	332
Yeovil District Hospital NHS Foundation Trust	Small	1,083	1,173	2,248	1,258
York and Scarborough Teaching Hospitals NHS Foundation Trust	Teaching	58	91	110	115

View this table in the data tables file

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